Choice at the end of life: do we have time to wait?

Following on from the health White Paper, the government last week published two new consultations - on choice and information. Together these could have significant implications for how end-of-life care is delivered.

The consultation on choice, Liberating the NHS: Greater choice and control, focuses on giving patients greater choice over how and where they are cared for. The government's pledge to open up the health care marketplace to 'any willing provider' backs up this commitment. A co-ordinated approach at a local level, involving a range of health and social care providers working collaboratively, is fundamental to reaching this goal.

It is particularly important to increase the range of available care for people approaching the end of their lives. We know that many more people would choose to be cared for, and to die, at home than are currently able, and the consultation proposes establishing a 'national choice offer' for people to receive the support necessary to die at home (including a care home) if that is their preference.

A review to consider when this choice will be introduced nationally will be undertaken in 2013, five years after the publication of the End of Life Care Strategy, which currently guides the commissioning and provision of end-of-life care across England.

We welcome the government's continued commitment to improving end-of-life care and enabling greater choice across England. But why wait until 2013 to make improvements?

In our own work on this subject over the past few years, we have seen many examples of regions working to improve access to supportive care for patients as they near the end of life. It is vital that this energy is not lost.

The King's Fund report, Implementing the End of Life Care Strategy: lessons for good practice, which is published today, highlights some of these examples seen through our work with the Marie Curie Delivering Choice Programme.

We have used the end-of-life care pathway outlined in the strategy – from diagnosis and early discussions of care options, through to bereavement support – as a guide to highlight examples of good practice for commissioners and service providers, so they can consider these when working locally to more effectively meet the care preferences of people nearing the end of life.

At present, end-of-life care is often inadequate in meeting patients' care preferences, and our new report provides the necessary impetus for driving reform at a local level.

The coalition government's pledge to review this choice agenda in 2013 risks stalling the current energy and focus in this area. We would strongly encourage commissioners and service providers to continue the developments they are undertaking now to improve choice for patients at the end of life.

Read the report: Implementing the End of Life Care Strategy: lessons for good practice

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Comments

#264 Ann
consultant

We are all in fear of a culture in the NHS when we go into hospital after the age of 60years.. doctors and nurses are administering morphine without consent from the patient or the family, do you consider that good end of life care?

There is evidence that there is a culture to rid the elderly who are putting too much pressure on the NHS.

I believe although morphine to be a very useful drug in the terminally ill, this is being abused and has to STOP!

What are the figures in the use of Diamorphine in all hospitals in the UK, is this available?

There are no laws in place to protect us on the abuse of diamorpine in this country…yet no one wants to discuss the subject, including the Marie Curie who refused to comment for a program on ITV regarding the concerns surrounding the LCP.

Drugs used in the Liverpool Care Pathway have been under much speculation. Although an audit of Care of the Dying, by the Marie Curie and the Royal College of Physicians in 2009 found that nearly 4000 terminal patients found the framework to be of high quality, there is no doubt that some patients remain at risk.

There is room in current practice for elderly, vulnerable patients to be started on the LCP without their or their family’s consent; it is not good enough to assume that in all hospitals, hospices and care homes that conversations will take place and that patients and families will be kept informed.

The audit reveals that two thirds of the 3,893 patients whose deaths were assessed needed no continuous infusion of medication, and all by 4% only needed low doses of opiates. However, there have are cases where patients have been started on high doses of opiates and sedatives via infusion and died prematurely.

It is no good giving good examples as a guide to highlight examples of good practice for commissioners and service providers, so they can consider these when working locally to more effectively meet the care preferences of people nearing the end of life, who is taking heed of them?

It does not work and proves today it is not working for the majority of patients and their families. I totally agree why does this government need to wait until 2013 before implementing choice and what choice do we have without a law in place to stop involuntary euthanasia.

Until the Marie Curie fully addresses the LCP with openness and transparency and GOOD medial practice all these statistics mean nothing, they are numbers and not real people! The Wessex guidelines being the same protocol as the LCP was not adhered to at the Gosport War Memorial and other hospitals, so little has changed, according to your statistics.

WE should not have to fight for life after we die the law should be there in place to protect us before death and that is why I am campaigning for "Elsie's Law" with the power of Marie Cure it could happen if they want change..so walk the talk!

#359 EmB
NHS Trust

Wow; seriously scary comment. Who on earth rattled her cage badly enough for the ongoing ( and ongoing) rant about Morphine given without consent; where did THAT come from?
I really hope that is not normal practice elsewhere, because I do not see it in practice where I work.
Of more concern is the corrosion of staffing levels , resulting in an inability to give the highest level care at all times;the care given becomes a bit of a lottery because of that.
I do not believe "we are all in fear of a culture in the NHS" etc; perhaps Ann should choose to take her consultant expertise elsewhere?
After all, practice decisions should come out of good leadership from senior clinical staff . . .

#372 Susan Skinner

Thank you consultant Ann. Keep speaking out. The standard doses for morphine infusions in some hospitals if accumulating in the patient's body, will become a lethal dose in about one and a half days. i.e. 30mg. the same amount as Shipman used on at least one occasion. The review to see if the patient is getting better is in 3/4 days.Only 8.5% of patients are not on morphine on the lcp, but 30% of cancer patients do not have pain. Wake up everybody!!!!!

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