The onward march of medicine led to a hospital culture where death was somehow seen as an admission of failure. ‘Heroic’ interventions were the norm, and this image was reinforced by television dramas in which doctors sweep through swinging doors to administer cardiopulmonary resuscitation.
As recently as five years ago many clinicians, often subconsciously, believed that hospitals existed solely to save lives.
Ensuring that people nearing the end of life had ‘a good death’ was left to the specialist palliative care team.
Since the Department of Health published the national End of Life Care Strategy for England in 2008, health professionals, policymakers and managers have increasingly recognised the need for change.
It might sound like a glib cliché, but end of life care is the business of everyone working in healthcare. Doctors working in almost every hospital department are likely at some point to be involved in the care of someone who is dying.
The nature of that care has changed in response to both medical advances and increased recognition of the right of individuals to have a voice in their own care.
As medical care has become more complicated and allowed more people with life-limiting conditions to live longer, more professionals and organisations have become involved in their care – requiring improved coordination and communication between both clinicians and organisations. Care planning has evolved as patients become more involved in their own care.
Some specialisms, such as kidney care, are already doing fantastic work around end of life care and have made it a core part of their everyday work.
However there is great variation both within trusts and between trusts. Recent years have seen the development of a number of worthwhile initiatives and tools that can improve the quality of care delivered to dying people. These include advance care planning, The AMBER Care Bundle, electronic palliative care coordination systems (EPaCCS), the Liverpool Care Pathway for the Dying Patient and rapid discharge home to die pathways.
However, in my role as deputy national clinical lead for end of life care I recognise that clinicians can feel both weary and wary of new tools and systems setting out what they should be doing to raise their performance to that of the best.
That is why I became heavily involved in developing a ‘how to’ guide for implementing those tools and resources. The NHS’s National End of Life Care Programme and the NHS Institute for Innovation and Improvement have just published the guide, which places the emphasis on helping hospitals implement what is already out there.
The new pack encourages senior clinicians to take a step-by-step approach, working with their teams, to address the sorts of issues and challenges I mentioned earlier, using the tools and systems already developed.
The thought of another officially-sanctioned guide to best practice might induce rolling eyes or a shrug of shoulders amongst busy doctors. The practical approach of this one and the prize – more people dying in their preferred setting after influencing the care they received – make me hope that is not the case.
Transforming end of life care in acute hospitals: the route to success ‘how to’ guide is available here.