Post Liverpool Care
Pathway
Arundel: 14th May 2014
Dr Bee Wee
National Clinical Director for
End of Life Care
• Pre-LCP
• LCP
• More Care Less Pathway report
• Post LCP
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National End of Life Care Strategy
2008:‘End of Life Care Pathway’
Step 1
Step 2
Discussions
as the end
of life
approaches
Assessment,
care planning
and review
Step 3
Coordination
of care
Step 4
Delivery of
high quality
services in
different
settings
Social care
Spiritual care services
Support for carers and families
Information for patients and carers
Step 5
Care in the
last days
of life
Step 6
Care after
death
NICE Quality Standard for End of Life
Care for Adults (20110)
Quality statement 11:
“People in the last days of life are identified in a
timely way and have their care coordinated and
delivered in accordance with their personalised care
plan, including rapid access to holistic support,
equipment and administration of medication”
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Independent review (Neuberger)
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Some key themes
• LCP used well – and also used badly
• System-wide approach
• Culture of care
• Education and training
• Lack of evidence base
• Accountability
• Documentation
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Clinical issues
• Individual care plan
• Decision-making
• Diagnosis of dying
• Food and fluids
• Sedation
• Use of syringe drivers
• Anticipatory prescribing
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Recommendations for….
• Department of Health
• NHS England
• Health Education England
• Care Quality Commission
• General Medical Council
• Nursing and Midwifery Council
• NIHR
• Royal Colleges
• and others…….
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Independent review (Neuberger)
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13 NHS | Presentation to [XXXX Company] | [Type Date]
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Fundamental differences
• Outcomes based approach
• From DH to multiple ‘Arms Length Bodies’
• ‘Unprecedented’ financial constraints
• Central – ‘National Support Centre’
• Matrix working
• Local commissioning
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The new landscape: local agenda
CCGs
Healthwatch
Health
and
wellbeing
boards
LETBs
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Commissioning Support Units
Local Area Teams
Clinical Senates
Strategic Clinical Networks
Local
authorities
PHE
National reports/reviews
• Francis 1st report (2010): 18 recommendations
• Francis 2nd report (Feb 2013): 290 recommendations
• ‘More care less pathway’ (July 2013): 44 recommendations
• Berwick report (Aug 2013): ‘ to specify the changes that are
needed’: 10 recommendations
Francis and Neuberger
• Francis 2 – 8:
• about culture and values
• Francis 185 and Neuberger 34:
• increased focus on compassionate care in nurse
training, education and professional
development
• Francis 13 and Neuberger 39:
• development of fundamental standards, which
are to be drawn up by the CQC, working with
NICE, commissioners, patients and the public
• Coalition of bodies to set standards
• Berwick
‘
and Neuberger
• A promise to learn – a commitment to act: Improving the
Safety of Patients in England’
• Acknowledging harm done and consider how best to
ensure that EoLC plans help minimise harm and ensure no
unnecessary harm
• Wider actions to improve care in response to the Berwick
report should reinforce specific actions being taken to
improve care in the last days and hours of life
•
Berwick and Neuberger
‘
• Berwick 4 and Neuberger 33 and 35:
• on making staff with the right skills available in the right locations to
support effective end of life care
• Berwick report stresses the need for continual learning:
• calls for an “ethic of learning” in the NHS (1)
• NHS to become a “learning organisation” (6)
• “mastery of quality and patient safety sciences and practices should be
part of initial preparation and lifelong education of all healthcare
professionals….” (5)
Francis and Neuberger: clinical links
• Francis 236 and Neuberger 14:
• senior responsible clinician in charge of a patient’s care
• Francis 241 and Neuberger 18 and 20:
• nutrition and hydration
• NMC and GMC guidance
• Francis 195 and Neuberger 27:
• ward nurse managers - should know about the care plans relating to
every patient on their wards
• Named nurse per shift responsible for leading care of the dying
patient
Francis and Neuberger: clinical links
• Francis 238 and Neuberger 30:
• communication with and about patients
• shared folder at bedside
• Francis 242 and Neuberger 23:
• medicines administration
• starting syringe driver
• Francis 243:
• recording of routine observations
• Pre-LCP
• LCP
• More Care Less Pathway report
• Post LCP
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Leadership Alliance for the Care of Dying
People
• Statutory organisations: DH and ALB
• Regulatory organisations
• Royal Colleges
• National charities
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Priorities for Care
1. Recognise deterioration – reversible or dying?
2. Sensitive communication
3. Involvement in decision-making
4. Needs of those close to the dying person
5. Individual plan of care
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