The review, chaired by Crossbench Peer Baroness Neuberger, published
its report
in July.
It concluded that the LCP should be phased out ‘over the next 6 to 12 months’ and replaced by an individual end of life care plan, ‘backed up by good practice guidance specific to disease groups’.
The Government backed
the recommendations and said it would ‘consider fully’ the committee’s recommendations
over the coming months, to inform ‘a full system-wide response to the review’s
recommendations in the autumn’.
The review highlighted a number of issues with the LCP,
including, amongst others: specific gaps in evidence on the LCP; difficulty of
diagnosing when a patient is actually going to die; issues with decision making
and consent; lack of relatives’ involvement in the patient’s care plan; issues
with hydration and nutrition; issues with sedation and pain management; a lack
of clear accountability in decisions relating to the LCP; a lack of compassion
in caring; scarce availability of staff at weekend or out-of-hours.
While acknowledging that prior to the introduction of the
LCP ‘the care that patients received was variable and there were many examples
of poor care’, the review panel made a number of recommendations for the
introduction of an individual end of life care plan which should be developed
by a coalition composed of various organisations.
The 44 recommendations made by the panel included the
following:
- Patients should only be placed on the LCP or a similar approach by a senior responsible clinician in consultation with the healthcare team.
- Unless there is a very good reason, a decision to withdraw or not to start a life-prolonging treatment should not be taken during any ‘out of hours’ period.
- An urgent call for the NMC to issue guidance on end of life care.
- An end to incentive payments for use of the LCP and similar approaches.
- A new system-wide approach to improving the quality of care for the dying.
Along with the results of the review, the Department of
Health published an Evidence briefing on pathways for the dying phase in end of
life care, which formed part of the evidence base used by the
independent review panel during its work.
Following the Government’s decision to implement the
Review’s recommendations, Care Services Minister Norman Lamb sent a letter to the
boards of all acute NHS Trusts asking them immediately to put into effect two
actions:
- Undertake a clinical review, led by a senior clinician, of each patient who is currently being cared for using the LCP or a similar pathway for the final days and hours of life, to ensure that the care they are receiving is appropriate and that the patient, where possible, and their family is involved in decisions about end of life care; and
- Assure themselves that a senior clinician is assigned as the responsible clinician to be accountable for the care of every patient in the dying phase, now and in the future.
In addition, the Minister asked that all complaints
about pathways for the dying should be ‘investigated properly’, with the
appointment of an independent assessor if required. Trusts should also consider
whether new evidence exists that would warrant a re-examination by the trust of
past complaints about the LCP, in light of the findings of the Review. Finally,
they should appoint a Board member with the responsibility for overseeing any
complaints about end of life care and for reviewing how end of life care is
provided.
On 30 August it was announced
that a Leadership Alliance for the Care of Dying People (LACDP) was being set
up under the chairmanship of Dr
Bee Wee, National Clinical Director for End of Life Care at NHS England,
to respond to the Independent Review.
NHS England, the Care Quality Commission (CQC), Department
of Health (DH), General Medical Council (GMC), Health Education England (HEE),
NHS Improving Quality (NHS IQ), Nursing and Midwifery Council (NMC) and the
National Institute for Health and Care Excellence (NICE) have already
signed up to join the alliance in order to:
- support everyone involved in the care of people who are dying to respond to the findings of the review;
- be the focal point for the system’s response to the findings and recommendations of the LCP review;
- provide guidance on what needs to occur in place of the LCP;
- consider how best health and social sector can address the recommendations in the review about the accountability and responsibility of individual clinicians, out of hours decisions, nutrition and hydration and communication with the patient and their relatives or carers
- map existing guidance, training and development factors that might affect the adoption of good practice.
The new leadership alliance has a great challenge before it,
but I hope that it is able to reach a strong evidence-based census about the
next steps forward to ensure that dying patients in Britain are optimally cared
for.
It will need to move quickly if public confidence is to be effectively restored.
It will need to move quickly if public confidence is to be effectively restored.
Previous reviews
Has this 'leadership alliance ' actually been formed yet? No one can provide a definitive list of its members. Denise Charlesworth Smith (a patient representative on the Neuberger panel) asked Dr. Bee Wee recently what was going on, and appears to have been given the 'cold shoulder', with Bee Wee citing a desire to avoid media interest.
ReplyDeleteMeanwhileTony Bonser (the other patient representative on the Neuberger Panel ) has been appointed a Trustee of the National Council for Palliative Care, where he sits alongside Marie Curie's ex Press Officer. They being holders of the LCP copyright.
As to the 'improvements' recommended....if one examines NHS Sheffield's ''personalised' documentation ( http://www.sheffieldccg.nhs.uk/Downloads/Your%20Health%20docs/eolcp_hospital.pdf ) we see that the 'personalisation' aspect merely includes an 'insert name here' section, and insisting the ' majority'' of the following should apply' (but don't necessarily have to):
• The patient is profoundly weak
• The patient is essentially bedbound
• The patient is drowsy for extended periods
• The patient is increasingly uninterested in food and fluid
• The patient finds it difficult to swallow medication'.
Consent to treatment is not even mentioned, just 'the decision of the MDT'....and whilst now allowing 'sips of water' to be offered to patients, this is at the same time that parenteral diuretics are administered....:)