End of life care guidelines under review

New palliative care guidelines have been published as part of a National Institute for Health and Care Excellence (NICE) consultation on measures that will replace the abolished Liverpool Care Pathway.

Key to the new direction is a commitment to making sure that a number of health experts consult on whether a patient is nearing the end of their lives, as previously this decision could be made by one doctor alone.

NICE chief executive, Sir Andrew Dillon, said: “Recognising when we are close to death and helping us to remain comfortable is difficult for everyone involved.

“The Liverpool Care Pathway was originally devised to help doctors and nurses provide quality end-of-life care. While it helped many to pass away with dignity, it became clear over time that it wasn’t always used in the way it was intended.

“Some families, for example, felt that elderly relatives were placed on to the Pathway without their knowledge or consent. Following a review, the Pathway is no longer used.

“Earlier this year, the parliamentary and health service ombudsman said that end-of-life care could be improved for up to 335,000 people every year in England. The guidelines we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care.”

Dr Catherine Millington-Sanders, clinical lead for End of Life at the Royal College of GPs, welcomed the consultation, saying: “It is crucial that patients approaching the end of their lives receive high quality and compassionate care that is tailored to their own needs and wishes. This guidance highlights how important it is for people to be involved in having discussions about their care.

“The clear difference between this and the Liverpool Care Pathway is that this is not a ‘pathway’ or process to be followed. This provides guidance on what good practice looks like and gives practical advice on issues that need to be considered when caring for a person in their last days of life.

“It suggests ways in which health and social care professionals can work together in a coordinated and timely way and make relevant decisions, such as the appropriate use of medications and equipment. This should support patient choice at this important time, and enable patients, wherever possible, to be cared for and to die in their preferred place, as well as supporting their families and their carers through the experience.”

The consultation is set to run until September 9, after which the new guidelines will be proposed.