Conclusions and recommendations
Beyond the Liverpool Care Pathway
1. Every
care provider should have a model in place based on the Five Priorities
for Care that will deliver personal, bespoke care to people at
the end of life. There should be no reason for any health or care
organisation not to have introduced an appropriate alternative
to the Liverpool Care Pathway. (Paragraph 34)
2. We recommend that
a senior named person in each NHS Trust and care provider is given
responsibility for monitoring how end of life care is being delivered
within their organisation. (Paragraph 35)
3. We welcome the
focus on end of life care by the Care Quality Commission and recommend
that they monitor both acute and community health care providers'
move to the new approach in their inspections and as part of their
thematic review. (Paragraph 36)
4. Generalist staff
in acute settings must be competent in identifying people who
are likely to be at the end of life, irrespective of their medical
condition, so that they can offer specialist care where it will
be beneficial. We recommend that NHS Trusts ensure that generalist
staff are provided with opportunities to learn from specialist
palliative care teams. (Paragraph 51)
Access to Palliative and End of Life Care
5. Roundtheclock
access to specialist palliative care will greatly improve the
way that people with life-limiting conditions and their families
and carers are treated. This would also help to address the variation
in the quality of end of life care within hospital and community
settings. We also recognise the value of specialist outreach services.
We recommend that the Government and NHS England set out how universal,
seven-day access to palliative care could become available to
all patients, including those with non-cancer diagnoses. (Paragraph
52)
6. People with dementia
should have equal access to end of life care as those dying as
a result of other conditions. Particular attention should be paid
to discussing and documenting their wishes as early as possible
following diagnosis. (Paragraph 53)
7. Commissioners should
explicitly set out how they will provide specialist palliative
care services for people from all backgrounds in their locality,
including children and adolescents, people from ethnic minority
backgrounds and those living in isolated or deprived communities
and how they will ensure that those with a non-cancer diagnosis
can also access specialist palliative care. (Paragraph 54)
Competence of the workforce
8. We
heard that too often staff lack confidence and training in raising
end of life issues with their patients or delivering the right
care. Training should be provided for all health and social care
staff who are likely to provide care to people at the end of life,
including training in communication skills. We recommend that
NHS England works with care providers to identify and roll out
tailored end of life care training. (Paragraph 75)
Advance Care Planning
9. We
believe there is a role for the Government and NHS England to
provide clarity and leadership with regards to the policy on advance
care planning and its implementation. We recommend that the Government
considers how it can further raise awareness of the mechanisms
available to patients and carers under the Mental Capacity Act
2005 to make their wishes clear about end of life care. This should
also include information about Advance Decisions to Refuse Treatment.
The Department should provide an update to our successor Committee
on the actions it has taken since publication of its response
to the House of Lords Select Committee Report. (Paragraph 88)
10. We recommend 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 the legal status of different options. Training
should be developed in partnership with the National Council for
Palliative Care and other non-government bodies with relevant
expertise. (Paragraph 89)
11. We recommend that
the Government engage with Age UK to understand the outcome of
their awareness raising pilots, learning lessons that can be applied
to supporting other groups as well as older people to understand
the options, and developing a strategy to promote advance care
planning to patients in different settings. (Paragraph 91)
12. We recommend that
the Government carry out a review of the cost of making a Lasting
Power of Attorney, including the impact on take up by people from
different socioeconomic groups, with a view to identifying any
financial barriers for those who have been unable to take out
LPAs, and what support is available to those who cannot afford
to use a legal route.
(Paragraph 93)
13. At present, should
a person completing the LPA application form make any error, they
are obliged to complete a new form and start the application process
again, including paying a second time. We recommend that the Government
review the LPA application process, with a view to making it simpler
and cutting costs for applicants. (Paragraph 94)
14. We recommend that
the Government encourage and monitor the take up of electronic
care planning and Electronic Palliative Care Coordination Systems
(EPaCCS), to facilitate information sharing between providers,
and that they review the best mechanisms to facilitate the understanding
and take up of these plans. We also recommend that the Government
explore options for a universal system for recording and filing
advance care plans, with a standard template for use across England
and a website dedicated to explaining the issues. (Paragraph 98)
15. The Department
of Health has notified the Committee that NHS England is working
with Health Education England to develop a single accredited curriculum
for paramedic training that will ensure that paramedics have the
skills they need to resolve more calls on the phone (hear and
treat) and at the scene (see and treat). We expect end of life
care to feature in the new curriculum when the details are issued
later in 2015. (Paragraph 99)
Do Not Attempt Cardiopulmonary Resuscitation Orders
(DNACPR)
16. We
recommend that the Government review the use of DNACPR orders
in acute care settings, including whether resuscitation decisions
should be considered in the context of overall treatment plans.
This Committee believes there is a case for standardising the
recording mechanisms for the NHS in England. (Paragraph 108)
Community resourcing
17. We
recommend that Health Education England and NHS England set out
how they plan to address the shortfalls in the staffing of community
care services. The Committee sees this as essential to enabling
people to die at home and in other community settings including
care homes and nursing homes, where that is their preference rather
than in hospital. This should involve their plans for the recruitment
and training of district nurses. (Paragraph 113)
Free social care at end of life
18. We
recommend that the Government clarify the eligibility criteria
for the NHS Continuing Healthcare Fast Track Pathway and phase
out the social care means test (financial assessment) for people
at the end of life. (Paragraph 134)
19. This Committee
strongly recommends 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. (Paragraph 135)
20. We recommend that
the Government set out what it intends to do to ensure sustainable,
long term funding for the hospice sector as part of their response
to the Palliative Care Funding Review. (Paragraph 136)
21. We recommend that
the Government ensure that their proposals for the future funding
of palliative care fully recognises the importance of the voluntary
sector. (Paragraph 137)
Bereavement support
22. Bereavement
support provision is currently fragmented, with services not consistently
provided around the country. Family members and carers are too
often left inadequately supported. We recommend that the Government
and NHS England raise awareness amongst health and social care
staff of the impact of bereavement and provide for universal access
to bereavement services in its funding plans for palliative care.
(Paragraph 144)
Measuring quality of care
23. We
recommend the development of outcome measures for palliative care.
These must be properly evaluated and funded in order to improve
the quality of care for people at the end of life. (Paragraph
150)
Research into Palliative and End of Life Care
24. We
recommend that the Government pursue the research priorities that
matter most to people with terminal illnesses, their families
and carers and the staff providing care professionally to them,
and set out what funding will be provided to ensure that future
policy on palliative and end of life care is informed by a robust
evidence base. (Paragraph 155)
Leadership
25. The
Five Year Forward View sets out a direction of travel for the
NHS in England, covering all the major statutory bodies. The Department
of Health and NHS England should ensure that end of life care
is prioritised and embedded in future planning at all levels.
They should identify named individuals who will be responsible
for ensuring that the new approach to end of life care, based
on the Five Priorities, is delivered nationally. (Paragraph 159)
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