8. End of life care
Swansea Branch
(R) In light of the ongoing controversy over the Liverpool Care Pathway, RCN Congress asks Council to lobby for improved training and education in end of life care
Result
The resolution was passed
For: 99.34% (451)
Against: 0.66% (3)
Abstain: 4
Debate report
Keira Jones, from the RCN Swansea Branch, asked Congress delegates to send a message to Council to lobby for improved training and education in end of life care.
The majority of people want to die at home, yet 56 per cent die in hospital, she said. Keira explained that the Liverpool Care Pathway (LCP) was initially introduced to try to ensure patients had a dignified death and as a means of introducing a way of talking about patient and family choices. But appropriate training was needed for these difficult conversations to take place, she said. The LCP is just a tool, she said, and nursing staff had to remember that it doesn’t replace common sense or clinical judgment. Placing someone on the pathway was a multidisciplinary decision, and the document contains no reference to a need to withdraw food or drink, she reminded delegates.
The resolution was seconded by Gwen Vardigans who emphasised the importance of communication in reaching joint decisions to overcome the taboo of discussing death.
Criticism of the pathway in the media should not disguise the fact that the tool is very good, said Neil Thompson, who supported the need for adequate training and support for nursing staff.
Diane Yarwood spoke from personal experience, telling delegates about the care her mother-in-law received before her death, just two weeks ago. She spoke of how she was asked hesitantly if she had heard of the LCP. She said she was relieved to have been asked but recognised the discomfort in the practitioner who put the question to her. This, she said, was an example of why it was so important to ensure that appropriate communications training was given.
Siobhan Taylor reminded delegates that the LCP is a document to be personalised and that recent negative media reports have made it more difficult for nursing staff to talk about it with families.
Doreen Crawford asked that the RCN consider working on national guidance for end of life care for children.
The resolution was passed with an overwhelming majority.
Background
The Liverpool Care Pathway (LCP) is internationally recognised as best practice guidance to support care for patients in the final days and hours of their life. It influences the distinct integrated pathways for end of life care in Scotland, Wales and Northern Ireland, and is used holistically to support end of life care in England.
Since the late 1990s, the LCP has been helping to bring elements of hospice care into hospitals, care homes and patients’ homes. It aims to support decisions with a patient, and their relatives or carers, about the care they would like to receive in the final days of their life.
The LCP is intended to support the delivery of excellent palliative care and promote patient choice by ensuring decisions to either continue or stop a treatment (where, for example, an intervention may cause distress) are taken in the best interests of the patient.
In recent months, however, the use of the LCP in England has been heavily criticised, with a number of serious accusations about its implementation calling into question whether health care professionals are sufficiently trained to use the LCP as intended.
A number of critics (including relatives of patients) have suggested the LCP is effectively being used as a form of euthanasia. The media has reported claims of clinical decisions being linked to financial incentives, with hospitals being offered money to meet targets in relation to the LCP. Claims have emerged of patients being deprived of food or fluids, or other life-sustaining interventions, in their final days. There have also been critical allegations of a lack of communication between health care professionals and patients and their relatives, whose consent has not been sought before adopting the LCP.
For it to be implemented as intended, the pathway relies on health care professionals being adequately trained to fully understand its use, and acquire the skills and confidence to meaningfully discuss end of life decisions with patients, relatives and carers.
Last October the RCN signed a consensus statement, supporting the appropriate use of the LCP, and in November was invited to take part in a Government roundtable discussion on this issue, chaired by Health Minister Norman Lamb. The Minister subsequently announced an independent review of the pathway led by Baroness Neuberger, with whom we hope to meet shortly.
The RCN has also developed the joint End of Life Care Patient Charter with the Royal College of General Practitioners, and this year will be delivering further training, following the workshops on end of life care which we delivered with the National Council for Palliative Care and the National End of Life Programme last year.
References and further reading
Department of Health (2013) Review of Liverpool Care Pathway outlined London: DoH. Available at: www.dh.gov.uk/health/2013/01/review-lcp/ (accessed 13/03/13) (Web).
Liverpool Care Pathway Consensus Statement (2012) Consensus statement: Liverpool Care Pathway for the Dying Patient (LCP) London: LCPCS. Available at: www.rcn.org.uk/data/assets/pdf_file/0011/477677/Liverpool_Care_Pathway_consensus_statement.pdf (accessed 13/03/13) (Web).
