• Make sure the existing End of Life Care Strategy is fully implemented over the coming years.
• Commit to making end of life care a political priority by establishing a Cabinet Committee.
• Implement an out of hours service so that dying people have access to specialist palliative care services and nursing around the clock.
• Train all health and social care staff in the principles and application of end of life care.
• Raise awareness of the Dying Matters coalition, which encourages people to express their wishes and priorities around palliative care.

NCPC chief executive Eve Richardson comments: ‘Bad end of life care should now be regarded as completely unacceptable, in the same way as any other failure of care. We believe that everyone has the right to access high-quality palliative care services and be able to exercise choice about their place of care at the end of their life. The momentum must continue.’

One of the issues raised within the current debate over legal euthanasia is the question of whether the Liverpool Care Pathway is being used appropriately by hospitals and care homes. The Pathway was introduced in 2007 as part of the Government’s National End of Life Care Programme, with the aim of ensuring that patients and their families receive the highest possible standards of care during the terminal phase of a patient’s illness and immediately after their death. One aspect of the Pathway requires medical staff to identify cases where further treatment is inappropriate and to withdraw it accordingly. However, a national audit undertaken by the Royal College of Physicians and the Marie Curie Palliative Care Institute indicates that in some cases, patients who are not terminally ill are being put on the Pathway and having drugs, food and water withdrawn – leading to death by dehydration. Typically, patients in this situation are suffering from serious, long-term illnesses such as Parkinson’s, dementia or stroke, but would still benefit from ongoing medical treatment. There is a growing concern that, within the 300 hospitals and 560 care homes where it is used, the Pathway is being used for ‘involuntary euthanasia’ – made more worrying by the audit’s discovery that 28% of relatives are not informed that the patient has been transferred to the Pathway. Peter Milliband, emeritus professor of geriatrics at the University of London, comments on the report: ‘The risk…is that elderly people with chronic conditions like Parkinson’s or respiratory disorders may be dismissed as dying when they could still live for some time. The Government has said let’s develop a service to help people die at home – what they should be doing is helping them live. Only when death is unavoidable should you start withdrawing treatment.’

posted by Cheselden Continuing Care at
10:34

The Times has discovered that £286 million of funding allocated by the Government to improve end of life care services has not been used for this purpose. 90% of PCTs surveyed by the charity Help the Hospices said that the money has been ‘lost on the NHS balance sheet’ or redirected to other areas. The funding, to be supplied over two years, was announced in July 2008 by the then health secretary Alan Johnson and was supposed to be used to help more people die at home rather than in hospital. 28 PCTs were surveyed and only three could prove that they had spent more money on palliative care this year than last year. Other Trusts stated that they had been unable to spend extra money on end of life care due to financial pressure, or that they could not identify a specific amount for this purpose on their annual allocation, or that they had not received any extra money. David Praill of Help the Hospices comments: ‘This is a tragic indictment of the system. PCTs have been given a substantial amount of money to improve end-of-life care, and it simply isn’t good enough that, one year on, many don’t know where it is.’

However, a Government review of end of life care published on 14 July tells a different story. It claims that the £286 million funding programme ‘..had made a good start and was set to deliver real service improvements’. The Department of Health has stated that it is using some of the funding ‘for national work’ as well as allocating money directly to PCTs.

At present, around 20% of people die at home in England, although it is a stated preference for almost 70% of those who die following a chronic illness. 58% of people die in hospital due to a lack of hospice beds and of the support and pain management services that would enable more of these people to die at home.

posted by Cheselden Continuing Care at
13:03

The NHS and Isle of Wight council have launched a month-long consultation process to gather thoughts and opinions on the IoW’s new end of life care strategy. The strategy aims to support the physical, emotional and spiritual needs of patients and their carers. In particular, it will enable people to die at home if they want to and if their care needs permit. The NHs also hopes that a new approach to end of life care will reduce the number of complaints that it receives from relatives. The three year strategy has received input from a wide range of sources including the IoW’s hospice, GPs, patients’ representatives, care and nursing home staff. Chief Executive of the IoW NHS Keith Flynn comments on the strategy: ‘This draft strategy sets out how we aim to meet the preferences of Islanders so more people can die in a place of their choosing. “It is our understanding many people would prefer to die somewhere other than hospital and the strategy envisages more people being able to choose.’ You can find out more about the consultation process at the Isle of Wight NHS website.

posted by Cheselden Continuing Care at
12:44

The sector skills councils Skills for Health and Skills for Care have unveiled a new set of key skills for all staff that work with terminally-ill people. The move comes in response to the Government’s End of Life Care Strategy, published in July 2008, and is designed to bring about ‘a cultural shift in attitudes and behaviour related to end of life care’ amongst staff working in care homes, hospitals and other settings. Staff will be expected to train in the new competencies and principles in addition to any existing training that they need to undertake for their specific occupation. The core competencies are defined as communication, care assessment, symptom management and advance care planning. These are underpinned by a set of principles which include fully involving the patient in all aspects of their care; keeping families and friends informed about choices and available support; and delivering care in a sensitive, patient-focused manner. You can download the full document outlining the new key skills at the NHS’s end of life care website.

posted by Cheselden Continuing Care at
14:12

South West Essex PCT has announced that it will be providing funds to enable better end-of-life care in the county after NHS chiefs admitted that too many patients are dying in hospital simply because there is nowhere else for them to go. The Trust is spending £161,000 on improving services such as palliative care and hospices-at-home as well as providing more places in residential and nursing care homes. Terminally-ill patients who want to die at home will also now have access to drugs that were previously available only to patients in hospital. The PCT aims to reduce the number of people in Essex that die in hospital by 75% over the next five years; Basildon Hospital currently has one of the highest death rates in England. Hospital spokeswoman Luenne Featherstone comments: ‘Sadly, many…patients die while waiting to be transferred to more appropriate care settings…We will continue to work very closely with NHS and community services to ensure sufficient hospice, residential and nursing home provision is available to transfer patients sooner.’

posted by Cheselden Continuing Care at
13:53

The Nursing Times has published an article establishing the principles of palliative care nursing and end-of-life care. The article defines palliative care according to the World Health Organisation and to the UK standards set out by the National Council of Palliative Care. It then explains how palliative care is an integral part of nursing: ‘…nursing and palliative care are natural partners in clinical practice and…the knowledge and skills required in this area are applicable to all nurses… The values and beliefs that underpin high-quality palliative care are integral to good nursing.’ The author, Robert Becker, then describes the current government strategies for palliative and end-of-life care in the UK, which increasingly focuses on patient choice and self-determination within health and social care settings. In particular, the patient’s choice about the place of death is now considered a key priority. The article can be read at the Nursing Times website.

posted by Cheselden Continuing Care at
16:57

The Nursing Times reports that the Government’s cancer director, Professor Mike Richards, wants PCTs to fund 24 hour community nursing services to allow terminally-ill patients to die in their own homes or in a care home. The Government’s End of Life Care Strategy for England is to include the setting-up of fast-response nurse teams to undertake this care. With these measures, Professor Richards hopes that both patient suffering and unnecessary hospital admissions will be minimized. Click here to view the story on the Nursing Times website.

In a related story in the Manchester Evening News, Trafford GPs have called for long-term, chronically-ill patients to be given electronic monitors in their own homes to alert surgery staff to any changes in their condition, reducing the patient’s stay in hospital. Read more about this and other plans to improve health services in the Trafford area on the MEN website.

posted by Cheselden Continuing Care at
17:30