Overhaul of End of Life Care system
The Government is to replace the Liverpool Care Pathway (LCP) and will ask senior clinicians to sign off all end of life care plans, as part of its response to the findings of an Independent Review.
The Review, headed by Baroness Julia Neuberger, was established by Norman Lamb after concerns were raised by patients, families, carers and a number of clinicians that the system for providing care in the last days and hours of people's lives was flawed.
The review found that in the right hands and when operated by well-trained, well-resourced and sensitive clinical teams the LCP does help patients have a dignified and pain-free death. But its findings included too many cases of poor practice, poor quality care of the individual, with families and carers not being properly engaged in the patient's care. Because of these failings in its use, the Review has recommended it should be phased out.
The Government has published an initial response to the Review, which includes a series of actions for the health and care system, including that:
- all NHS hospitals should immediately undertake clinical reviews of all care given to dying patients. Led by senior clinicians, these reviews will ensure the care all patients are receiving is appropriate
- all NHS hospitals should ensure that arrangements are put in place as soon as possible so that now and in the future every patient has a named senior clinician responsible for their care in their final hours and days of life
- NHS England should work with CCGs 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
- the LCP is phased out over the next 6-12 months and replaced with an individual approach to end of life care for each patient, which will include a personalised end of life care plan backed up by condition-specific good practice guidance, agreed with a named senior clinician
- the CQC will undertake a thematic review into end of life care and the three new Chief Inspectors – of Hospitals, Social Care and General Practice – will consider end of life care issues as they develop their new approaches to inspections.
In addition, greater assurance will be given to families that their complaints or concerns are being properly listened to. Anyone with worries about how their loved one has been treated at the end of their life will have access to an independent assessment of their case. To support this independent assessment, the Government will make available a list of experts to provide local support for patients if needed – and all NHS hospitals will be asked to appoint a Board member with responsibility for overseeing any complaints about end of life care and for reviewing how end of life care is provided.
In addition, patients and families who have previously made complaints about care received on the Liverpool Care Pathway but whose cases were not resolved satisfactorily will have the opportunity to have their case reviewed.
In all those cases where evidence of poor care or malpractice is found, professional regulators will be asked to consider action. Families also will be able to pursue other routes of redress including making negligence claims against the Trust.Care and Support Minister Norman Lamb said:
"We hope the actions we have taken today will reassure patients and their families that everyone coming to the end of their life is getting the best possible care and that concerns are being dealt with swiftly.
"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.
"People's final days should be as comfortable and dignified as possible. That is why there is a place for thoughtful and careful end of life care that involves patients and their families, but it is clear what we have now needs to be replaced so we can create a better way of doing this.”
The Review made a number of recommendations to Government and other health and care organisations. The Government 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 to the Review's recommendations in the autumn.
To support these improvements to end of life care, Norman Lamb is also writing to the General Medical Council and the Nursing and Midwifery Council to highlight both 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.
The Independent Review has also identified themes highlighted by the Francis Inquiry, such as the need to put people first in decisions about their care and the need for staff to be more compassionate. The Government has already implemented a number of key reforms to improve care and compassion standards including:
- a new set of simpler fundamental standards that make explicit the basic standards beneath which care should never fall;
- a failure regime for quality as well as finance, and where the fundamental standards of care are breached, firm action is taken to ensure they are properly and promptly resolved;
- improving the quality of training and expected conduct of healthcare assistants to ensure safer and compassionate care;
- a new barring system for the small number of managers who let their patients and the NHS down through gross misconduct;
- a new criminal offence on providers responsible for wilfully generating misleading information or withholding information they are required to provide;
- helping to implement ‘Compassion in Practice', a three-year strategy for building the culture of compassionate care for nursing, midwifery and care staff;
- working with Skills for Care and Skills for Health to develop minimum training standards and a code of conduct for care workers - both will stress the importance of dignity and respect;
- spending £40 million to help nurses and midwives develop leadership skills and to help them and their staff provide high quality care.