Attention has again been focussed on the Liverpool Care Pathway, which clearly from the review needs to change. Uncertainty about the Pathway’s use and how it has been used in practice led to a high level review of its use as it was supposed to give an individual at the end of their lives the peaceful, dignified death they hoped for. The whole episode has damaged the special bond between clinicians and patients.
NHS North Kirklees CCG supports the phasing out of the Liverpool Care Pathway, but it needs to be replaced with another pathway – or way of doing things – which the public has been involved in shaping. Any new pathway or tool would need to focus on the needs of the patient and to make sure that there is effective communication between all parties, including other colleagues, the patients and their loved ones so everyone understands what is happening, when it’s happening and why it’s happening.
Primary care is about keeping people as well as they can be throughout their lives and managing illness as it happens – death is a part of life. We believe that end of life care is just as vital, so we’ve included death in our thinking about how we reshape and improve local NHS services.
We know that many people reaching the end of their lives would prefer to die at home – or a place which has become home such as a care home – in familiar surroundings with their loved ones close at hand. We’ve been looking at how we can make this easier and are about to begin to gather views on this from professionals and the community.
We also want to understand what prevents people being able to die at home when this is what they’d prefer. We’ll be asking about this and inviting local people to share their experiences and views with us.
One of the things we know we can do quickly is to allow nurses who have been trained to verify death. This doesn’t help the patient at end of life, but it can spare those they leave behind some distress by providing confirmation of death as quickly as possible. Currently in Kirklees it’s GPs who verify death – which can lead to distressing delays for the bereaved as they wait for a doctor who may be in surgery or on house calls to arrive to confirm that someone has died. The sooner death is confirmed, the sooner the unpleasant but necessary tasks of making suitable arrangements for the deceased can begin. If local people think this is a step in the right direction, we will make it happen.
I know death is not an easy subject – few of us really want to face our own mortality – but thinking about it and making views known can spare the patient and their loved ones a lot of anguish when the time comes and people who are organised can do this and there are some good sources of information such as the Dying Matters website.
Look out for more details about our consultation on this website in the next few weeks.