Dying care: 'Improved' guidelines proposed

England's health watchdog has put forward new draft guidance to improve the care of adults in their last few days of life.

It comes after concerns that misuse of the previous system - the Liverpool Care Pathway - led to some patients being deprived of water and food.

The guidelines encourage staff to involve patients and relatives in decisions and to communicate well.

The Department of Health and charities welcomed the move.

'Tick-box care'

The Liverpool Care Pathway was introduced in the late 1990s, in an attempt to ensure people had a dignified and comfortable death.

It involved a checklist to ensure patients were free from invasive procedures and medications that were no longer necessary.

But it faced increasing opposition, with some describing it as a a "tick-box exercise".

And an independent review found some patients had been left thirsty and decisions sometimes taken by inexperienced staff.

While the National Institute for Health and Care Excellence acknowledges many failings were down to how the pathway was implemented - rather than a direct consequence of the document itself - the new draft proposals are designed to address these problems.

The wide-ranging guidance intended for patients, relatives, hospitals, hospices and others involved in end-of-life care is open for public review until September 2015.

It focuses on providing personalised care, good communication and shared decision-making between staff, relatives and patients when appropriate.

NICE also says people important to the dying person should be encouraged to help with giving drinks if they wish.

Staff are advised to undertake daily reviews of medication and hydration and checks to see if the patient has improved.

If there is any uncertainty about the best course of action, staff must seek help from more experienced colleagues.

End-of-life care is everybody’s business and there is only one chance to get it right
— Claire Henry, National Council for Palliative Care


The charity, the National Council for Palliative Care, says it supports the focus on individual care.

Claire Henry, chief executive, said: "It is not a tick-box exercise that someone just has to follow. It focuses on individual needs.

"People need to have meaningful choice and be involved in decisions about their end-of-life care, allowing them to maintain comfort and dignity until they die. That's why we welcome the draft consultation."

However, she added that health and care staff needed to be provided with ongoing training "as end-of-life care is everybody's business and there is only one chance to get it right".

Prof Bee Wee, at NHS England, said: "We want to ensure that people who are dying receive the best possible care, including effective communication between them, their loved ones and the professionals looking after them.

"This draft guidance is therefore welcome, and I would encourage members of the public and professionals alike to contribute to the consultation."

Source: http://www.bbc.co.uk/news/health-33693619