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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Study Suggests UK is World Beater in End of Life Care

The quality of end of life care in the United Kingdom has been ranked as the very best in the world in a recent study.

A report conducted by the Economist Intelligence Unit was hugely complimentary regarding the quality and availability of such services within the UK.

The study examined 80 countries worldwide, and particularly praised the NHS and hospice movement within the UK, describing the quality of care in the country as “second to none”.

As would perhaps be expected, developed economies generally performed well in the study.

Australia and New Zealand ranked second and third in the report, but there was also some encouraging news for developing economies and the third world.

The Economist Intelligence Unit found that the quality of care in some of the poorest nations on the planet had improved considerably, with African nations ranking surprisingly highly in the study.

Mongolia was rated as highly as 28th by the Economist Intelligence Unit, with its investment in hospice facilities considered particularly important.

Meanwhile, Uganda, ranked 35th in the report, has managed to improve access to pain control through a public-private partnership.

Rankings in the study were calculated by utilising assessments of the quality of hospitals and hospice environments.

In particular, the Economist Intelligence Unit assessed  staffing numbers and skills, affordability of care and quality of care.

And although the results related to Britain were encouraging, the overall picture was rather disturbing for the quality of end of life care worldwide.

Less than 50 per cent of the countries survey provided what the report classed as a good end of life care, with only 34 of the 80 countries reported on considered to be adequate.

Not only was this a relatively paltry number in terms of total nations, but the percentage of the global population that they represented was even smaller.

The 34 nations considered to be good in terms of end of life care only accounted for approximately 15 per cent of the adult population.

Yet despite the relatively poor level of end of life care indicated by the study, the report in fact suggested that this aspect of healthcare is becoming increasingly important.

An ageing population ensures that people around the world are increasingly facing “drawn-out” deaths.

Already there have been a demographic problems with greying populations in such countries as Japan and Germany, and this trend is expected to accelerate and encompass the rest of the developed world in the coming decades.

Report author Annie Pannelay praise the quality of end of life care in the UK, but also suggested that there is still room for improvement.

“The UK is an acknowledged leader in palliative care. That reflects its comprehensive strategy towards the issue as well as the improvements that are being made. But there is more that the UK could do to stay at the forefront of palliative care standards, such as ironing out occasional problems with communication or symptom control,” Pannelay commented.

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End of life care receives funding boost to improve service standards

Proposals for improving the quality of end of life care services – including an additional £130m of funding – are contained in a new report published today.

Produced by the Choice in End of Life Care Programme Board, the report – What’s Important to Me: A Review of Choice in End of Life Care – was commissioned to provide advice to Government on improving the quality and experience of care for adults at the end of life and their carers.

The independently-led report makes a number of proposals, including: (i) establishing a ‘national choice offer’ focused on individual’s end of life care needs by April 2020; (ii) providing an additional £130 million funding for end of life health and social care services, (iii) establishing 24/7 community end of life care by 2019 in all areas; (iv) implementing shared electronic end of life care records by April 2018 in all areas; and (v) the appointment of a named responsible senior clinician for all people approaching the end of life.

“It is vital that we are supported to be ourselves as we near the end of our lives”, said Claire Henry MBE, chair of the Choice in End of Life Care Review Board. “We need to recognise how and where the attitudes and actions of individuals and society as a whole, as well as the structures of the health and care system, must change.

“Many of the problems that we have identified in this advice are not new. While it is important to acknowledge that many positive changes have been made in recent years in the way end of life care services are provided in this country, there is still a great deal to be done to ensure that everybody’s needs and preferences are known and met.

“As a society we all have a role to play; end of life care is everyone’s business and needs to be recognised as such. This report provides a blueprint for Government and the health and care system, as well as wider society. People have told us what they want. Now is the time for action.”

A large number of organisations contributed to the report including: NHS England, National Care Forum, Cicely Saunders Institute, University of Nottingham, Nuffield Trust, Together for Short Lives, Macmillan Cancer Support, and NHS Improving Quality.

The report: What’s Important to Me: A Review of Choice in End of Life Care


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