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The big question: what would you like to see covered in the new end-of-life care guidance?


NHS England is setting up a coalition of health and social care organisations to draw up guidance on end-of-life care following the withdrawal of the Liverpool Care Pathway.

The Leadership Alliance for the Care of Dying People will be chaired by Dr Bee Wee, national clinical director for end-of-life care at NHS England. Among its members are the Care Quality Commission, the National Institute for Health and Care Excellence, and the Nursing and Midwifery Council.

The creation of the alliance was recommended by the independent review that called for the pathway to be scrapped.

What are the issues that you would like to see addressed in the new guidance?

Your comments could be published in Nursing Times.


Readers' comments (9)

  • Ellen Watters

    I'd be very surprised if the final guidance looks that much different to the LCP.

    However I think training is a must. It should be standard practice to ensure that all relevant HCPs are given training on the implementation of any guidelines.

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  • I would like to see finance of end of life care discussed. How do we finance what people want for end of life care as opposed to what they might need / how do we address sustainablity? How can we supply / afford 24 hr care in a patients own homes during the final days if this is what they want? With ever tightening budgets how can we sustainably afford night care etc? how do we promote the role of the family etc when families are more likely to be working / live away etc
    Finance of end of life care is a real issue with little being done to address it. Its all very well telling people they can choose where they wish to die but surely we have to have the financial resources to beable to supply the care they need should they wish to die in their own homes?

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  • michael stone

    The issues I'd like to see properly addresses are the ones around decision-making and consent (proper guidance about the concept and application of Informed Consent and a proper explanation of the Mental Capacity Act's section 4, section 24-26 and section 42, and how these fit with or conflict with 'patient confidentiality'), a new approach for EOL while patients are at home which does NOT 'focus on process' (because live-with relatives cannot be expected to be familiar with 'process' but usually they are the only people actually present when decisions need making: so 'process-based behaviour' can work in hospitals and hospices, but not at home), a stress on adequate communication, and proper categorisation of EoL deaths which does not simply use the inadequate concept sof 'expected' and 'unexpected'.

    I would also like the replacement for the LCP to be described as a framework, not as a plan (Neuberger review's preference).

    Inter Alia !

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  • michael stone | 5-Sep-2013 3:33 pm

    what is the difference between guidelines, protocols, care plans, clinical pathways and frameworks, and i suspect there are some more of these terms?

    do they have different applications?

    do they mean the same to everybody or something different?

    is it important to take this into consideration and be sure the new replacement for the LCP has an appropriate name which will be very clearly understood by everybody involved in its use?

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  • michael stone | 5-Sep-2013 3:33 pm

    If you find these questions of any interest, here are some answers to start with:

    From the European Pathways Association


    Clinical / Care pathways, also know as critical pathways, care paths, integrated care pathways, case management plans, clinical care pathways or care maps, are used to systematically plan and follow up a patient focused care program.

    Clinical pathways are used all over the world [1-3]. Although their wide use, there are many uncertainties involved:
    Firstly, the terminology and the way they are defined and developed is unclear [4-8].
    Secondly their impact is unclear. Several reviews on the effect of clinical pathways [4;10-21] describe a variety of outcomes.

    De Luc et al [6] found 17 different names describing this concept. In literature most frequently the terms clinical pathway, critical pathway, integrated care pathway and care map are used [4;5]."

    from Wiki

    "Difference between clinical pathway and nursing care plan?

    In: Nurses [Edit categories]


    The process in nursing care plan involves assessment, nursing diagnosis, planning, implement and evaluation. Clinical pathways involves the multidiscipline team and the decisions based on evidence."

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  • michael stone

    Anonymous | 5-Sep-2013 5:23 pm

    The Neuberger review was of the same basic opinion as me: the terminology should be pretty-much clear to everyone, laymen as well as clinicians - it is counter-productive, if clinicians are being trained to use a word such as 'pathway' in a specialised sense, that is counter-intuitive to patients and relatives.

    As for both ACP and Care Planning, these are hugely problematic until clinicians improve their understanding of the Mental Capacity Act and, indeed, of simple logic.

    It seems the England will no longer have the term 'pathway' in connection with EoL, but it isn't clear that 'pathway' would also disappear in Scotland and Wales, which would make a dog's breakfast of a situation even messier, in my opinion.

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  • Time and place to air your views and get advice on LCP at a Conference 30th Sept, 13, Westminster University, Nr Baker Street, 1-5pm. 1- 5

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  • For info and a chance to discuss LCP the above Health Conference in Westminster Uni, 30th Sept, 1-5 ring Theresa 07721372786 for details:-

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    30TH SEPT. 1-5PM

    CONTACT THERESA 07721372786

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