post liverpool care pathway arundel: 14 th may 2014 dr bee wee national clinical director for end of...

Post Liverpool Care Pathway

Arundel: 14th May 2014

Dr Bee Wee

National Clinical Director for

End of Life Care

NHS | Arundel / 14 May 20142

• Pre-LCP

• LCP

• More Care Less Pathway report

• Post LCP

National End of Life Care Strategy 2008:‘End of Life Care Pathway’

Step 2

Assessment,care planning

and review

Step 3

Coordinationof care

Step 4

Delivery ofhigh qualityservices in

differentsettings

Step 5

Care in thelast days

of life

Step 6

Care afterdeath

Discussionsas the end

of lifeapproaches

Step 1

Social care

Spiritual care services

Support for carers and families

Information for patients and carers

NICE Quality Standard for End of Life Care for Adults (20110)Quality statement 11:

“People in the last days of life are identified in a timely way and have their care coordinated anddelivered in accordance with their personalised care plan, including rapid access to holistic support, equipment and administration of medication”


Independent review (Neuberger)


Some key themes

• LCP used well – and also used badly

• System-wide approach

• Culture of care

• Education and training

• Lack of evidence base

• Accountability

• Documentation


Clinical issues

• Individual care plan

• Decision-making

• Diagnosis of dying

• Food and fluids

• Sedation

• Use of syringe drivers

• Anticipatory prescribing


Recommendations for….• Department of Health

• NHS England

• Health Education England

• Care Quality Commission

• General Medical Council

• Nursing and Midwifery Council

• NIHR

• Royal Colleges

• and others…….


Independent review (Neuberger)


NHS | Presentation to [XXXX Company] | [Type Date]13

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NHS | Presentation to [XXXX Company] | [Type Date]14

NHS / Arundel / 14 May 201415

Fundamental differences

• Outcomes based approach

• From DH to multiple ‘Arms Length Bodies’

• ‘Unprecedented’ financial constraints

• Central – ‘National Support Centre’

• Matrix working

• Local commissioning

NHS | Arundel 14 May 201416

The new landscape: local agenda

CCGs

Local authorities

Health and

wellbeing boards

Commissioning Support UnitsLocal Area TeamsClinical SenatesStrategic Clinical Networks

Healthwatch

PHE

LETBs

National reports/reviews

• Francis 1st report (2010): 18 recommendations• Francis 2nd report (Feb 2013): 290 recommendations• ‘More care less pathway’ (July 2013): 44 recommendations• Berwick report (Aug 2013): ‘ to specify the changes that are needed’: 10 recommendations

Francis and Neuberger• Francis 2 – 8:

• about culture and values

• Francis 185 and Neuberger 34:

• increased focus on compassionate care in nurse training, education and professional development

• Francis 13 and Neuberger 39:

• development of fundamental standards, which are to be drawn up by the CQC, working with NICE, commissioners, patients and the public

• Coalition of bodies to set standards

Berwick and Neuberger• ‘

• A promise to learn – a commitment to act: Improving the Safety of Patients in England’

• Acknowledging harm done and consider how best to ensure that EoLC plans help minimise harm and ensure no unnecessary harm

• Wider actions to improve care in response to the Berwick report should reinforce specific actions being taken to improve care in the last days and hours of life

Berwick and Neuberger• ‘

• Berwick 4 and Neuberger 33 and 35: • on making staff with the right skills available in the right locations to support effective end of life care• Berwick report stresses the need for continual learning: • calls for an “ethic of learning” in the NHS (1) • NHS to become a “learning organisation” (6) • “mastery of quality and patient safety sciences and practices should be part of initial preparation and lifelong education of all healthcare professionals….” (5)

Francis and Neuberger: clinical links• Francis 236 and Neuberger 14:• senior responsible clinician in charge of a patient’s care• Francis 241 and Neuberger 18 and 20: • nutrition and hydration• NMC and GMC guidance• Francis 195 and Neuberger 27:• ward nurse managers - should know about the care plans relating to every patient on their wards• Named nurse per shift responsible for leading care of the dying patient• Francis 237 and Neuberger 14 and 33:

• teamwork to provide collective care for elderly patients

• decision to initiate end of life care plan OOH

• palliative care access

Francis and Neuberger: clinical links

• Francis 238 and Neuberger 30:• communication with and about patients• shared folder at bedside• Francis 242 and Neuberger 23: • medicines administration• starting syringe driver• Francis 243: • recording of routine observations

NHS | Arundel 14 May 201423

• Pre-LCP

• LCP

• More Care Less Pathway report

• Post LCP

Leadership Alliance for the Care of Dying People

• Statutory organisations: DH and ALB

• Regulatory organisations

• Royal Colleges

• National charities


Priorities for Care

1. Recognise deterioration – reversible or dying?

2. Sensitive communication

3. Involvement in decision-making

4. Needs of those close to the dying person

5. Individual plan of care


post liverpool care pathway arundel: 14 th may 2014 dr bee wee national clinical director for end of...

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