The government has confirmed it will replace the Liverpool Care Pathway and instead ask senior clinicians to sign off all end of life care plans, following an independent review.
The review, headed by Baroness Julia Neuberger, was established by care and support minister Norman Lamb after concerns were raised that the end of life care pathway was flawed.
In its report published today, the review concluded that in the right hands, and when operated by well-trained, well-resourced and sensitive clinical teams, the LCP helped patients have a dignified and pain-free death.
But it also found too many cases of poor practice, poor quality care and relatives not being properly engaged.
The review made 44 recommendations most notably that the LCP should be phased out and “replaced by a personalised end of life care plan, backed up by good practice guidance specific to disease groups”.
Other recomendations include that, unless there is a “very good” reason, a decision to withdraw or not to start a life-prolonging treatment should not be taken during any out of hours period
In addition, the Nursing and Midwifery Council should urgently issue guidance on end of life care and there needs to be a new system-wide approach to improving the quality of care for the dying, the review added.
As a result, ministers said today that the LCP would be phased out over the next six-12 months and replaced with an individual approach to end of life care for each patient.
This will include a personalised end of life care plan backed up by condition-specific good practice guidance, agreed with a named senior clinician.
The government also said all NHS hospitals should immediately undertake clinical reviews of all care given to dying patients.
In addition, all hospitals should ensure arrangements are put in place as soon as possible so every patient has a named senior clinician responsible for their care in their final hours and days of life.
Meanwhile, NHS England has been told to work with clinical commissioning groups 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.
Mr Lamb is also writing to the NMC and General Medical Council to highlight 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.
He said: “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.”
The government said it 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 in the autumn.
Chief nursing officer for England Jane Cummings responded to the report on behalf of NHS England.
She said: “I have been a nurse for over 30 years and know how important care at the end of life is for our loved ones. I say this both on a professional and a personal level.
“The review and NHS England recognise the good principles of end of life care in the LCP, but there have been failings in the quality of care in some areas and this is never acceptable. Caring for someone when they are dying is difficult and emotional even for experienced healthcare professionals.”
She added: “Most of the time we do get it right but we have to get it right for everybody. Issues such as poor communication with relatives have nothing to do with any particular care plan. That is just poor care and we don’t want it in the NHS.”
An NMC spokesperson said: “This is an important report in a sensitive area. We will consider the report and its recommendations carefully with our partners and respond in due course.
“We take very seriously any suggestion that nurses have falsified records relating to discussions about end of life care, and other allegations of unacceptable practice. We will follow this up with the review team.”
Peter Carter, Royal College of Nursing chief executive and general secretary, said: “There is only one chance to get care right at the end of any person’s life.
“It is at the heart of all caring professions that patients must be treated with dignity, and that means that all treatment has to be properly communicated. No patient should be left in the position where they or their families are suffering and don’t understand what is happening with their care.”
He added: “The RCN is working with other organisations and professions to produce guidance to help nurses deal with this difficult area, and this report contains a great deal of practical advice and insight to help inform this.”
Professor Jane Maher, chief medical officer of Macmillan Cancer Support, described the LCP as a “brave and important attempt to tackle the taboo subject of how to best care for people at the end of life”.
But she said: “Poor implementation can result in the upsetting findings highlighted in today’s report.
“Macmillan welcomes the move to individual care planning, but it’s vital staff are supported and trained to have the right culture and skills in place, and to talk to patients and their families early on,” she added.
“All professionals should see it as a core part of their job to help patients and their loved ones to think about end of life. Everyone must feel comfortable having conversations about dying so they and can plan the care they receive in the last hours or days of life.”
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