Advising with empathy and experience

Call for improvements in palliative care.

More investment is needed to improve the "inconsistent and often poor" care of dying people, say palliative care experts.

The King's College London lecturers also fear relatives are sometimes excluded from "critical conversations" about the end of their loved one's life.

They add that the NHS does not always have the capacity to provide "time and continuity."

The experts from the Cicely Saunders Institute, which examines palliative care policy, highlight a recent report from the Parliamentary and Health Service Ombudsman (PHSO) which shows that most NHS complaints focus on the last year of life.

They project that the number of people dying in the UK each year is likely to increase by another 100,000 in the next few years - added to about half a million people now.

One lecturer, Dr Jonathan Koffman, said: "At the moment there's too much inconsistency and poor quality care for people at critical moments in their life.

"They experience poor management of really distressing symptoms. This is not a vocal constituency - often they can't talk. The family members who are subsequently bereaved are too wounded by these experiences to help us work out what to do better."

The National Institute of Health and Care Excellence (NICE) is still consulting about its draft guidance on end-of-life care, published in July.

Two years ago, the government announced that previous care guidelines - the Liverpool Care Pathway - were being phased out, after saying that they had become a "checklist".

Another palliative care lecturer from King's College London, Dr Katherine Sleeman, said: "An audit last year showed only one in five NHS trusts mandate training for doctors in palliative care but 100% of them are going to have to care for someone who's dying."

Dr Sleeman said she was publishing research soon which shows how the Liverpool Care Pathway became misused.

She added: "It was intended as a guide but it became a protocol. It was used as a crutch because people simply didn't know any better. The review and phasing out was very hard for nurses on the wards. They told us they didn't know what to do but that made me feel that getting rid of it was the right thing to do."  



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