Time to refocus on the essentials of good end of life care

Anita Hayes Programme Delivery Lead End of Life Care NHS Improving Quality

One chance to get it right, the much-anticipated pronouncement from the Leadership Alliance for the Care of Dying People, gives everyone involved in end of life care a chance to take stock and focus on what really matters when supporting people in their last days.

The new statement represents a system-wide response following a widespread engagement exercise with professionals and the public. It not only outlines the priorities for care of the dying person but establishes a new direction of travel as the Liverpool Care Pathway for Dying Patient is phased out.

In future there will be no blueprint or protocol for how care is delivered for dying people. The focus must be the person who is dying. Each of the five priorities for care supports the primary principle that individual care must be provided according to the needs and wishes of the dying person and those who are important to them.

But although the Leadership Alliance concentrates specifically on the last days of life, its main messages are relevant to all aspects of good end of life care. They relate to the importance of sensitive communications, dignity and compassion and involving individuals and families in decisions at every step of the way.

It cannot be over-emphasised how vital this is. As Dame Cicely Saunders, the founder of the modern hospice movement, put it: “How people die remains in the memory of those who live on.” A good death can bring healing in the same way that a poorly managed one can become a lingering hurt – and, as the Leadership Alliance says, we only have one chance to get it right.

Ensuring all staff who encounter dying patients are familiar with the new priorities will require not only education but also a culture change. It means challenging the taboos that still exist around dying and death and confronting our own and the public’s reluctance to talk about the subject.

We need to be prepared to talk about this more but above all to carefully listen to what our patients and their family are telling us, including the public – and then strive to ensure those wishes are fulfilled wherever this is possible.

As a member of the Leadership Alliance for the Care of Dying People, NHS Improving Quality welcomes and fully supports the core messages of One chance to get it right. We are committed to ensuring that everyone who is in the last days and hours of life, and those important to them, receive high quality care, tailored to their needs and wishes and delivered with compassion, competence and respect. We will do all we can to support making change happen in practice and to improve the care of dying people.

We will also seek, as appropriate, to support organisations and professionals as they review their arrangements for ensuring they continue to deliver excellent care for dying people. The core resources from the Alliance – including guidance for health and care staff and commissioners and service providers – are now available on our website to help professionals and the public make change happen. Over the coming months we will be sharing more resources and publications on our website, including examples of good practice that can be implemented locally

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