Hospital Dr News

Seniors to sign off all end-of-life care plans

The Liverpool Care Pathway (LCP) is to be replaced and the government will ask senior clinicians to sign off all end-of-life care plans in future, as part of its response to the findings of an independent review.

The Review, headed by Baroness Julia Neuberger, was established by Norman Lamb after concerns were raised by patients, families, carers and a number of clinicians that the system for providing care in the last days and hours of people’s lives was flawed.

In its report published today, the review found that in the right hands and when operated by well-trained, well-resourced and sensitive clinical teams the LCP does help patients have a dignified and pain-free death. But its findings included too many cases of poor practice, poor quality care of the individual, with families and carers not being properly engaged in the patient’s care. Because of these failings in its use, the Review has recommended it should be phased out.

The government has called for all NHS hospitals to immediately undertake clinical reviews of all care given to dying patients, and to put a senior clinician in charge of every dying person’s care.

It also calls on NHS England to work with CCGs to bring about an immediate end to local financial incentives for hospitals to promote a certain type of care for dying patients, including the LCP.

The LCP will be phased out over the next 6-12 months and replaced with an individual approach to end of life care for each patient, which will include a personalised end of life care plan backed up by condition-specific good practice guidance, agreed with a named senior clinician;

Furthermore, the CQC will undertake a thematic review into end of life care and the three new Chief Inspectors – of hospitals, social care and general practice – will consider end of life care issues as they develop their new approaches to inspections.

Anyone with worries about how their loved one has been treated at the end of their life will have access to an independent assessment of their case.

Care and support minister Norman Lamb said: “We hope the actions we have taken today will reassure patients and their families that everyone coming to the end of their life is getting the best possible care and that concerns are being dealt with swiftly.

“I have personally heard families describe staff slavishly following a process without care or compassion and leaving people suffering at the end of their lives. This is something we cannot allow to go on. People’s final days should be as comfortable and dignified as possible. That is why there is a place for thoughtful and careful end of life care that involves patients and their families, but it is clear what we have now needs to be replaced so we can create a better way of doing this.”

Dr Linda Patterson, clinical vice-president of the Royal College of Physicians, commented: “It is estimated that every year 355,000 new people require end of life care. Palliative medicine is a huge area and the RCP is clear that patients deserve high quality, appropriate and compassionate end of life care.

“Care of the dying needs to be fully embedded into doctor training and education for doctors and healthcare professionals, and we must ensure senior clinical involvement in end of life decisions across seven days a week. Full and clear communication is fundamental to end of life care. Clinicians must have adequate time to discuss available options with the families and carers of their patients.

“Medical leadership is key to improving end of life care, especially in acute hospitals. The RCP is keen to work with other organisations to act on the recommendations of this review.”

The government will consider fully the recommendations of the review and over the coming months will be working with these organisations, stakeholders and charities to inform a full system-wide response to the recommendations in the autumn.

To support these improvements to end of life care, Lamb is also writing to the General Medical Council and the Nursing and Midwifery Council to highlight both the need for effective guidance on supporting nutrition, hydration and sedation for the dying, and also to stress the importance of professional regulation issues raised by the report.

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