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Government commits to ‘high quality’ end of life care by 2020


NHS and care professionals will be expected to “reflect” six new commitments in their work surrounding end of life care, the government has announced.

Made in response to an independent review of end of life care, they include having “honest discussions” with patients who are dying, better care planning and more “informed” choices on care.

The Department of Health set out the six commitments yesterday, saying they were intended to end “variation in end of life care across the health system by 2020”. In full, the commitments are:

  • honest discussions between care professionals and dying people
  • dying people making informed choices about their care
  • personalised care plans for all
  • the discussion of personalised care plans with care professionals
  • the involvement of family and carers in dying people’s care
  • a main contact so dying people know who to contact at any time of day

New measures will be developed to ensure local health and care leaders are meeting the standards expected of them, added the government.

It said plans were already underway to ensure experts could provide specialist support on end of life care by acting as a first point of contact for anyone who needed them, as part of urgent and emergency care hubs currently being developed in all local areas.

“Every person nearing the end of their life should expect a good death”

Ben Gummer

The experts would be available 24 hours a day, seven days a week to help with symptom control or deteriorating conditions late at night or at the weekend, as well as clinicians who had questions or needed additional support.

In addition, there will be a “focus” on improving the training for clinicians, including a national plan aimed at sharing best practice among NHS staff, said the DH.

Pilots in Southend and Airedale will be launched to trial new ways to support clinicians to initiate meaningful conversations with dying people about serious illnesses.

Department of Health

DH moves to quicken FtP process and end midwife supervision

Ben Gummer

A potential new role, a care coordinator, will also be tested with the aim of helping patients have more choice and control at end of life.

Meanwhile, innovative community care pilots, including 24/7 specialised nursing services for end of life care, will be tested in a number of areas.

Announcing the measures, health minister Ben Gummer said: “Our commitment is that every person nearing the end of their life should expect a good death: attentive, dignified and compassionate care.

“To do this, we will address poor care where it exists and accelerate improvement across the health and social care system in England,” he said.

The announcement by the DH was made in response to report – called What’s important to me: A review of Choice in End of Life Care – which was published in February 2015.

Published by an independent board chaired by Claire Henry, chief executive of the National Council for Palliative Care, it offered a blueprint for how greater choice in end of life could be achieved.

“I’m pleased by the overall vision set out in the government response”

Claire Henry

Among its recommendations were that each patient should be offered a care coordinator who would be their “first point of contact”, as well as a named senior clinician who would have overall responsibility for their care and their preferences.

In addition, it said there needed to be “more honest and open” communication about end of life issues, with better support for healthcare professionals and increased awareness among the public.

It also called for a new right in the NHS Constitution for everyone to be offered choice in the end of life care, and for these choices and preferences to be recorded in a personal plan of care.

Responding to the DH, Ms Henry said: “I’m pleased by the overall vision set out in the government response. They have clearly acknowledged our report, and taken its recommendations seriously.

“It will be vital that we continue to work with the government to ensure all these commitments are realised as part of all future care delivery,” she said.

However, another report, also published this week, warned that an overload of policy recommendations is making it harder for nurses and other health professionals in England to deliver quality end of life care.

Written by Sheffield Hallam University, the State of the Nations report looked at policy on terminal illness in all four UK nations. It found 76 different government publications relating to the subject had been published in England since 2004.

Meanwhile, draft guidance from the National Institute for Health and Care Excellence has outlined what the best palliative care for children looks like.

The draft emphasises the need for infants, children and young people to be treated as individuals and highlights the importance of children and their families being involved in decisions about care.


Readers' comments (48)

  • Not before time, now we have posative quidance, now all we need is Nursing Homes paid the same as Trusts and Hospices.
    Why is there the massive disparity I wonder. CCGs do not seem to have an answer.

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  • The vision seems helpful.

    Does this mean then that elderly people with complex needs will be communicated with adequately on a daily basis in line with their personal needs instead of being treated as objects then dosed up inappropriately with anti psychotic drugs when they retaliate?

    When will this vision materialise? -because it is so distressing to see so-called carers delivering negligent treatment to vulnerable people because they are following orders from the so-called "Responsible Individuals" in charge of care homes who are cutting costs on the recommendations, I believe, from Clinical Commissioning Groups, who are, I believe, being too enthusiastic about keeping costs for care of the elderly low because they are advised mainly, I believe, by people like accountants and doctors who have not a clue usually about how to deliver cost effective residential care?

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  • michael stone

    I only just found this - so I've not yet read it properly, nor have I followed up the links. But this seems to be almost identical to what I've been 'banging on about' for some years, and with a slight reservation, I really like this list:

    honest discussions between care professionals and dying people
    dying people making informed choices about their care
    personalised care plans for all
    the discussion of personalised care plans with care professionals
    the involvement of family and carers in dying people’s care
    a main contact so dying people know who to contact at any time of day

    My reservation hinges on the difference between 'what has to be offered' and 'what has to happen', For example:

    'personalised care plans for all'

    Patients must be OFFERED the chance to 'construct a personalised care plan' - but, it has to be the patient's decision as to how far to go along the 'care plan' route: some patients might (and I think with good reason) say 'sorry, this 'planning' seems too prescriptive. because I have not died before, and I suspect that as it is a new experience to me, my decisions and wishes might change day-to-day and in ways that I cannot foresee - so I'd prefer to explain my decisions and wishes, in a much more real-time way as things happen, rather than trying to make guesses about what they would be in a 'care plan''.

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  • michael stone

    Just started to read the actual PDF - what NT reported was a simplification, and the PDF itself does say 'given the opportunity to' (on its page 10):

    Our commitment to you is that as you approach the end of life, you should be given the opportunity and support to:

    have honest discussions about your needs and preferences for your physical, mental and spiritual wellbeing, so that you can live well until you die;

    make informed choices about your care, supported by clear and accessible published information on quality and choice in end of life care; this includes
    listening to the voices of children and young people about their own needs in end of life care, and not just the voices of their carers, parents and families;

    develop and document a personalised care plan, based on what matters to you and your needs and preferences, including any advance decisions and your views about where you want to be cared for and where you want to die, and to review and revise this plan throughout the duration of your illness;

    share your personalised care plan with your care professionals, enabling them to take account of your wishes and choices in the care and support they provide, and be able to provide feedback to improve care;

    involve, to the extent that you wish, your family, carers and those important to you in discussions about, and the delivery of, your care, and to give them the opportunity to provide feedback about your care;

    know who to contact if you need help and advice at any time, helping to ensure that your personalised care is delivered in a seamless way.

    ALTHOUGH 'there is a lot in that, which will be 'a challenge to deliver'.

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  • Stone, I hope it occurs to you that every single individual patient is different and so are all their very different circumstances surrounding their process of dying which I will not waste my time spelling out to you. All those surrounding them and involved in their care are also individuals and professionals come together as a team to reach consensus on a plan in order to provide in all measure possible continuity of care. This care is informed by a very complex combination of different elements, which I have no time to detail, but include background training in the areas of medicine, nursing and everything surrounding these disciplines as well as philosophy, spirituality, the law, various healthcare policies and the care needs of the whole person from the day they are born and very much more. As well as the above, clinicians also bring their own personal elements and in addition their professional and personal experience, expertise, evidence based knowledge, empathy, and an understanding, where possible, of the life and wishes of the patient and above all their highly developed capacity for both deductive and intuitive thought. Guidelines have been drawn up by a panel of these experts and those around the world taking all aspects of dying patients into consideration. It is the duty of clinicians to consult these guidelines and intelligently adapt the recommendations to the needs of each and every patient according to their own unique set of needs and any problems confronting them. Professionals, however, are fully autonomous in their own right and work together with others and their patient to make the best possible decisions to inform their care. Not every single clause in the guidelines is relevant to the care of every patient and trying to follow them blindly does not lead to high quality or safe care and can be highly detrimental to the patient. Nurses are not robots but sentient human beings like those they care for and are very well trained and qualified in alll of the skills for the job they do. Please therefore stop trying to tell them how to do their job and persistently trashing the profession and this site.

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  • I failed to get much sense from the previous comment. I do hope that verbose person with no time to spare is not the one doing my end of life care.

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  • And I hope you are fortunate enough that he or she is. The comments are thoughtful, intuitive and above all, compassionate. Perhaps also a little ideological, but if we don't aim for the best, how can we hope to achieve it?

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  • I agree with anon. just do it

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  • JULY, 2016 7:34 PM

    Thanks for your kind comment. Mine is ideological maybe but based on my own experience and practice I had the privilege to be involved in for over 20 years in a 1,000-bedded state of the art university hospital In Europe which is a model of clinical excellence where staff work together in interdisciplinary teams to provide the best individualised care for each and every patient which is becoming increasingly challenging in a world of rapidly developing clinical advances, changing demographics due to shifting populations and economic uncertainties. End of life is the one certainty facing us all where there is only one chance for those accompanying the individual to endeavour to get it right for each and every individual and it is imperative to 'manage' it well.

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  • 7 JULY, 2016 6:53 PM

    It is difficult to condense such a broad and important topic into the space of a comment in a limited time and it was addressed to another reader.

    When my end comes I would like to be looked after by caring staff like my my former colleagues in a hospital such as I worked in with this excellent and compassionate model and philosophy of care and where a staff of autonomous and highly qualified and experienced professionals all worked together with the patient to find the optimal solutions to offer them the very best quality of care. Obviously this also relied upon excellent communications at every level which also required a certain degree of time and verbosity to make sure everything was very clear and well understood and agreed upon by all involved and and with the chance to discuss ideas or any objections raised which is always a good way of eliminating misunderstandings and avoiding potential conflict. Other languages do not have such an extensive vocabulary as English so communications are often more repetitive for emphasis and to try and ensure this clarity.

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