New end of life care regime set out

The decision to scrap the regime - which recommended the withdrawal of treatment, food and water from some sedated patients in their final hours or days - has been called into question by some corners of the medical profession, with many questioning how patients would be cared for in the final hours and days of their lives.

In July last year it was announced that the measure would no longer be used after an independent review concluded doctors had used the LCP “as an excuse for poor quality care”.

The review panel, chaired by crossbench peer Baroness Neuberger, said they were “shocked” and “upset” at some of the “distressing” cases of appalling care.

Patients were left on the pathway for weeks without any review and some patients’ families were even shouted at by nurses for giving them water.

Now the government has published its response to the review which includes details in the new approach on how to look after those nearing the end of life.

The Priorities for Care approach sets out five targets which health workers should aim to provide dying patients.

The approach recommends that care is tailored to the individual and says that patients should be supported to eat and drink for as long as they wish to do so.

It states that patients are made aware that they are nearing the end of their life and that decisions about care are made in accordance with the person’s needs and wishes.

These decisions should be reviewed and revised “regularly”, it adds.

It also takes into account the needs of the friends and family of those who are dying.

The priorities were created by a coalition of 21 organisations known as the Leadership Alliance for the Care of Dying People including the Department of Health, care regulators, health officials, charities and a number of royal colleges.

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.”

Jane Cummings, chief nursing officer for England, added: “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.

“They also underline the importance of sensitive and effective communication between staff and the person who is dying and those close to them.”

Dr Maureen Baker, chairwoman of the Royal College of General Practitioners - which was part of the alliance - said: “Today’s announcement should provide much-needed clarity for doctors and, most importantly, much-needed reassurance for patients and their families and carers.”

Charity Marie Curie, which also made up part of the alliance, said the introduction of the priorities was an “important moment” for end of life care in England.

“This is a real opportunity to tackle the massive variations in the care provided for people in the last days of life in hospitals across the country, as well as shine attention on our attitudes towards death and dying, the recognition of the importance of advanced care planning, and the care and support that all terminally ill people and their families receive,” said Dr Jane Collins, chief executive of the charity.

Claire Henry, chief executive of the National Council for Palliative Care, added: “There can be no excuse for not treating people with dignity, compassion and respect when they are dying, at the very time that they most need this.

“The challenge now is to turn ambitions into action, and principles into practice.”