NICE Instigates New End of Life Care Guidelines

The health regulator NICE has suggested that end-of-life care in England must be more adequately tailored to the actual needs of individual patients.

NICE suggested that the current approach lacks respect and compassion, and it is important that doctors should make more assiduous decisions about the physical state of a patient.

The guidance is designed to address misuse of the previous system, the Liverpool Care Pathway.

Instead, NICE compared the existing system to a tick-box approach, opining that there is considerable room for improvement.

NICE particularly indicated that any system going forward should involve checklists that enable staff to make informed decisions about invasive procedures, drips and drugs.

While NICE acknowledged the majority of people are given good care, the watchdog called for a stronger focus on individual plans for each patient, stating that the wishes of families must be central to the palliative process.

Commenting on the findings from the NICE report, Professor Sam Ahmedzai suggested that there need to be fundamental changes in the way that the health service deals with people in the last vestiges of existence.

“You have to look at each individual person and respect them as an individual person, ask them about their wishes. Some people may want interventions, may want tests to carry on. Others may want to stop all those things. Some people may want fluids, others may not want fluids. So respecting the individual and not having a one-size-fits-all approach.”

However, it was acknowledged by the expert panel that satisfactorily recognising whether someone is in the last few days of life can be problematical and challenging.

Yes staff are too infrequently seeking guidance from senior colleagues over uncertainties.

The document also looked closely at hydration for people in their last few days of life.

NICE indeed indicated that patients should be encouraged to drink if they are able to do so.

But despite the recommendations of NICE, experts have stated that withholding fluids may have little influence over the duration of life in the final throes of existence.

Lord Howard, chairman of Hospice UK, broadly supported the new guidelines.

“There can never be ‘a tick-list approach’ towards caring for the dying and this guidance must be underpinned by greater investment in training and education for all staff involved in end-of-life care. This is crucial if we are to avoid the failings of how the Liverpool Care Pathway was implemented.”


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