In a report published today, the Health Select Committee looks at the state of end of life care since the independent Review of the Liverpool Care Pathway, chaired by Baroness Neuberger, and found great variation in quality and practice across both acute and community settings. It makes a number of recommendations for improvement, and in particular recommends that social care should be free at the end of life.
Some of the MPs’ conclusions were:
- All clinicians and providers who may care for people at the end of life should be aware of the Five Priorities of Care but in light of the variation in practice the Committee also recommends that a senior named person in each NHS Trust is given responsibility for monitoring how end of life care is being delivered within their organisation
- the focus on end of life care by the Care Quality Commission was welcome and recommended that CQC monitor both acute and community health care providers’ move to the new approach in their inspections and as part of their thematic review
- Round-the-clock access to specialist palliative care in acute and community settings would greatly improve the way that people with life-limiting conditions and their families and carers are treated, especially if there were opportunities to share their expertise with other clinicians. Crucially this expertise should be more equitably available to people with a non-cancer diagnosis, older people and those with dementia, for whom early identification and sensitive discussion and documentation of their wishes is also important
- The situation on end of life care is unlikely to improve unless clinicians feel confident to identify people who may be near the end of life and to start conversations with their patients about their wishes. Too often, however, staff feel that they lack the confidence, skills and training needed to raise end of life issues with patients, let alone understanding the mechanisms available to patients and carers under the Mental Capacity Act 2005 which allow people to make their wishes clear. The Committee recommends that all staff who provide palliative and end of life care to people with life limiting conditions should receive training in advance care planning, including the different models and forms that are available and their legal status
- The use of Electronic Care Planning makes it easier to document and share people's wishes and care records between providers and also reduces the risk of an unwanted admission to hospital or failure to act on advance decisions to refuse treatment
- Most people who express a preference would like to die at home but that is made more difficult by the shortfall in community nurses and specialist outreach palliative care
- The Committee strongly recommended that the Government provide free social care at the end of life to ensure that no one dies in hospital for want of a social care package of support
- Sustainable, long term funding for the hospice sector also needs to be addressed as part of the Government's response to the Palliative Care Funding Review, as does full recognition of the importance of the voluntary sector
- Bereavement support for families should also be included as part of end of life care but availability is currently fragmented and inconsistent around the country. Family members and carers are too often left inadequately supported yet could be helped if there were greater awareness amongst health and social care staff of the impact of bereavement, as well as universal access to bereavement services
- We recommend further research into measuring the quality of end of life care and the priorities that matter most to people with terminal illnesses, their families and carers
- As is so often the case, we feel these important issues will not be addressed without clearly identified leadership to ensure that end of life care is prioritised and embedded in all future planning of services, based on the Five Priorities of Care, and delivered nationally to all those who could benefit
The Chair of the Committee, Dr Sarah Wollaston MP, said
"The care that people receive at the end of their lives has a profound impact not only upon them but also upon their families and carers. At the most difficult of times, their experience will be made worse if they encounter poor communication and planning or inadequate professional expertise. There are unacceptable levels of variation in the care that people receive and this needs to be addressed so that high quality end of life care is available to everyone regardless of their age, medical condition or where they live. We must make sure that specialist palliative care expertise is accessible within hospitals and community settings as well as within our hospices"
The Five Priorities for Care are that, when it is thought that a person may die within the next few days or hours
- This possibility is recognised and communicated clearly, decisions made and actions taken in accordance with the person’s needs and wishes, and these are regularly reviewed and decisions revised accordingly
- Sensitive communication takes place between staff and the dying person, and those identified as important to them
- The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants
- The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible
- An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, co-ordinated and delivered with compassion.