New guidance on end-of life treatment after Liverpool Care Pathway withdrawn

By The Press Association29th July 2015News EnglandEnd Of Life Care, Guidance, News England, NHS, Older People

Decisions on when patients are reaching the end of their life should be taken by a number of health experts rather than relying on the medical opinion of just one doctor, according to new guidance from health officials.

The draft guidelines from the National Institute for Health and Care Excellence (Nice) follow the abolition of the controversial Liverpool Care Pathway – a regime that recommended the withdrawal of treatment, food and water from some sedated patients in their final hours or days – which was phased out last year after a Government-commissioned review found serious failings in how it was being implemented.

Nice said its guidelines address concerns that fluids were being withheld under the pathway, and its recommendations include that people in their last days of life should be encouraged to drink if they wish to and are able to and receive assisted hydration if appropriate, but this be reduced or stopped if there is any sign of harm or no sign of benefit.

They also emphasise the importance of recognising when patients actually have a chance of recovery in the light of cases where elderly patients were being left to die when they could have got better.

Nice said around half a million people die each year in England and while around three quarters of deaths are expected, recognising when death is imminent can be challenging.

It said the new guidelines aim to help doctors and nurses identify when someone is entering their final few days of life and places the individual and their loved ones at the heart of decisions about their care.

People who are dying and those important to them should be fully involved in decisions about medicines for managing symptoms in the last days of life, it said.

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 onto 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 guideline we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care.”

The draft guidance is open for consultation until September 9.

Professor Bill Noble, medical director at Marie Curie, said: “We welcome the publication of the draft Nice guideline to help doctors and nurses identify when someone is dying and to improve the care that they receive in the last few days of life.

“We know from our own research that around 92,000 people a year in England miss out on palliative care, often because healthcare professionals don’t recognise that they are at the end of life.

“We also welcome Nice’s emphasis on research, which highlights serious gaps in the available research in understanding when people are dying and the medication and the care that they need. Just 10p out of every £100 spent on research goes to palliative and end of life care research.

“This research is important as it can help guide healthcare professionals who look after dying patients but who aren’t specialists in palliative care provide the high quality care that their patients need.”