Advising with empathy and experience

End of life care guidance.


New draft guidance has been put forward by England’s health watchdog to improve the care of adults in their final days.

The new guidance, from the National Institute for Health and Care Excellence (NICE) comes amid concerns that misuse of the previous system - the Liverpool Care Pathway - led to some patients being deprived of water and food.

The new guidelines, which have been welcomed by The Department of Health and interested charities, encourage staff to involve patients and relatives in decisions and to communicate better.

The Liverpool Care Pathway was introduced in the late 1990s to try to ensure that people have a dignified and comfortable death. It involves a checklist to ensure patients are free from invasive procedures and medications that are no longer necessary.

But the Liverpool Care Pathway faced increasing opposition, with some describing it as a "tick-box exercise" and an independent review found some patients had been left thirsty and decisions were sometimes taken by inexperienced staff.

NICE acknowledges that many failings in The Liverpool Care Pathway were due to how it was implemented, the new draft proposals are designed to address this.

The new guidelines focus on providing personalised care, good communication and shared decisions between staff, relatives and patients. Staff are advised to undertake daily reviews of medication and check if people are thirsty or need more nutrition.

NICE also says people important to the dying person should be encouraged to help with giving drinks if they wish. The guidelines also say that patients must be monitored for any improvements and, in case of uncertainty, staff should seek help from more experienced colleagues.

Prof Bee Wee, at NHS England, said: "We want to ensure that people who are dying receive the best possible care, including effective communication between them, their loved ones and the professionals looking after them.”