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New alliance looks at end of life care reform

It will consider accountability, responsibility, nutrition and hydration, and communication

Mark Gould

Monday, 02 September 2013

A new alliance of health regulators, educators and inspectors has been formed to respond to the independent review of the Liverpool Care Pathway.

It will consider how best health and social sector can address the recommendations in the review about the accountability and responsibility of individual clinicians, out-of-hours decisions, nutrition and hydration and communication with the patient and their relatives or carers: and map existing guidance, training and development, as a prelude to considering how these impact on the care of dying people and the circumstantial factors that might affect the adoption of good practice.

The pathway was developed during the late 1990s at the Royal Liverpool University Hospital, in conjunction with the Marie Curie Palliative Care Institute. It was intended to provide uniform, high-quality, dignified care for dying patients - whether they were in hospital, at home, in a care home or in a hospice.

Previously, there were concerns that care had been patchy, with some hospitals failing to meet acceptable standards and accusations that people were subjected to invasive treatment and testing that offered no chance of preventing death, but merely prolonged their suffering.

Under the LCP, patients were regularly reviewed to ascertain whether medication should be stopped - and whether fluids should be withdrawn once they ceased to be able to eat and drink.

In July a report by Baroness Julia Neuberger recommended that the pathway be phased out following complaints from families that their relatives were put on the pathway without their consent, and that death has been hastened in people who were not dying imminently.

The alliance says that patients, irrespective of whether or not they are on the Liverpool Care Pathway (LCP) or any other integrated care pathway, should receive high quality, compassionate care in the last days and hours of life, and their families should be supported. But it says this is not always the case and any inconsistency must be addressed.

In the report by the independent review of the LCP the review panel called for a coalition of regulatory and professional bodies to lead the way in creating and delivering the knowledge base, the education, training and skills and the long-term commitment needed to make high quality care for dying patients a reality, not just an ambition.

A Leadership Alliance for the Care of Dying People (LACDP) is being set up under the chairmanship of Dr Bee Wee, National Clinical Director for End of Life Care at NHS England, to do this.

NHS England, the Care Quality Commission (CQC), Department of Health (DH), General Medical Council (GMC), Health Education England (HEE), NHS Improving Quality (NHS IQ), Nursing and Midwifery Council (NMC) and the National Institute for Health and Care Excellence (NICE) have already signed up to join the alliance.

The alliance will support everyone involved in the care of people who are dying to respond to the findings of the review.

It will also be the focal point for the system’s response to the findings and recommendations of the LCP review and provide guidance on what needs to occur in place of the LCP.

The LACDP will engage extensively with both professionals involved in caring for dying people as well as individuals themselves and their families and other carers to gather views and ideas on good practice in caring for someone in the last days and hours of life.

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