Beyond the Liverpool Care Pathway

Transcription

1 Beyond the Liverpool Care Pathway Bridget Withell EOLC Facilitator

2 What was the LCP? What went wrong? The review What now?

3 Liverpool Care Pathway Originally developed by Marie Curie Centre & Royal Liverpool University Trust in late 1990s to improve the quality of care given to the dying patients on a general hospital ward (Ellershaw)

4 A nationally recognised, integrated care pathway which aimed to improve care during the last days or hours of life for patients in any care setting A single, comprehensive, multidisciplinary auditable record of care for dying patients Holistic approach which assessed physical, psychological, social & spiritual needs Emphasised effective communication, proactive planning and clear decision-making

5 Recommended model of best practice NHS Beacon Programme 2001 NICE guidance on Supportive & Palliative Care 2004 Our Health, Our Care, Our Say 2006 End of Life Care Strategy 2008

6 When was the LCP used? Would you be surprised if the patient died within a week? When the condition was no longer reversible and doctors would not act on any scan or blood results When members of MDT agreed the patient is likely to die When comfort measures were the primary goal

7 Diagnosing dying?

8 No definitive diagnosis Adherence to unrealistic or futile interventions Disagreement within HCPs about the patient s condition Failure to recognise key signs & symptoms Fear of communicating with family & pt Concerns about withdrawing & withholding treatment or do not resuscitate decisions Cultural & spiritual barriers

9 Empowered staff & increased confidence by outlining best practice Reduced inappropriate interventions Improved MDT working and decision-making Improved documentation Improved symptom management, promoted anticipatory care clear Measurable outcomes Enhanced family support & promoted best possible experience within the sad circumstances

10 Media critique & sensational headlines caused distress & unease among public and some health professionals (Watts 2013) Lack of robust research or strong evidence into efficacy & benefits of LCP (Parry et al 2013, Hughes et al 2013) LCP sometimes used in a routine manner by staff lacking compassion, palliative care knowledge & communication skills (Seymour & Horne 2013) Concerns were raised about the LCP and hydration & sedation issues Linked to financial incentives

11 First Media Offensive Sentenced to death on the NHS Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors have warned The Liverpool Care Pathway may be the slippery slope to backdoor euthanasia

12 Second Media Offensive Elderly patients are being deprived of food and drink so they die quicker and free up bed space claim doctors. Care pathway used to cut costs, claim doctors Care pathway? It s a licence to kill

13 Minister of State for Care Support ordered independent review, chaired by Baroness Julia Neuberger in spring 2013 Evidence from many quarters written, surveys, reviews, focus groups public & professionals 64 page report Balanced review Plenty of evidence... that when the LCP is used properly, patients die a peaceful & dignified death. But the panel is also convinced...that implementation of the LCP is not infrequently associated with poor care.

14 Review made 44 recommendations Use of the LCP should be replaced over the next 6-12 months by an end of life plan for each patient, backed up by condition-specific good practice guidance. Recommendations focus on communication, decision-making, professional guidance, system-wide approaches to improving care of dying...

15 No specific mention One quote from a pharmacist about MDT working Medication featured frequently in review concerns & misunderstandings re drugs given and regular drugs stopped Recommendation no 24 New research is needed on the use of drugs at EOL

16 Leadership Alliance for the Care of Dying People national alliance formed to respond to LCP review chaired Dr Dr Bee Wee (national clinical director for end of life care at NHS England) Alliance to include NHS, CQC, DH, GMC, NMC, NICE, NHS Improving Quality + others Set up to respond at a strategic and system-wide level to the review...to make high quality care for dying patients a reality, not just an ambition.

17 NHS England circulated general guidance after review published (Gateway no ) New plans appearing with familiar contents ( - reinventing the wheel? - or trying to preserve the good points from LCP?

18 Was the media furore about the LCP partly to do with our cultural terror of dying? Have advances in medicine raised unrealistic expectations? Will professionals become even more reluctant to diagnose dying? Was it wishful thinking to imagine that we could reduce good end of life care to a few pages of tick-boxes? Was the LCP blamed instead of the lack of investment in staff education and adequate resources? Or is this a great opportunity to re-think how we provide and promote good palliative care? What else could pharmacists do to support a system-wide approach to EOLC?

19 As we prepare to bury the LCP... LCP is there a new day dawning for end of life care?

20 Department of Health (2008) End of Life Care Strategy: Promoting High Quality Care for all Adults at the End of Life DH: London Ellershaw,J.E. & Wilkinson, S. (2005) Care of the Dying: A pathway to excellence Oxford University Press: Oxford Hughes S, Preston N, Payne S (2013) What went wrong with the Liverpool Care Pathway and how can we avoid making the same mistakes again? International Journal of Palliative Nursing 19,8, Neuberger J, Aaronovitch D, Bonser T et al (2013) More Care, Less Pathway. A Review of the Liverpool Care Pathway. Department of Health, Crown Copyright Seymour J, Horne G (2013) The withdrawal of the Liverpool Care Pathway in England: implications for clinical practice and policy International Journal of Palliative Nursing 19,8, Watts T (2013) The media critique of the Liverpool Care Pathway: some implications for nursing education International Journal of Palliative Nursing 19,6,