Agenda item

The Chairman invited Doctor Hannah Western, Consultant in Palliative Medicine, Deborah Sanders, Director of Nursing, and Tony Wright, PFI and Contracts Manager, all from the Royal Free London NHS Foundation Trust to the table.    

The Chairman introduced the item and noted that the Committee had previously considered a report from the North London Hospice on the removal of the Liverpool Care Pathway.

In introducing the report, Dr. Western advised the Committee that the Liverpool Care Pathway (LCP) was in place until 2013, when the Neuberger review recommended that it be phased out by July 2014.  The Committee noted that whilst this was prior to the acquisition of Barnet and Chase Farm Hospitals NHS Trust by the Royal Free London NHS Foundation Trust, both Trusts had responded to the review in a similar way. The Committee noted that in response to the removal of the pathway, the Leadership Alliance for the Care of Dying People was formed to provide national guidance for providers of healthcare on the care of dying patients.

Doctor Western informed the Committee that both Trusts had removed the Liverpool Care Pathway by September 2013 and had put temporary guidance in place. 

In July 2014, the Royal Free London NHS Foundation Trust started work on a response to “One chance to get it right” which was informed by the report of the National Care of the Dying Audit for Acute Hospitals. Doctor Western informed the Committee that it had become clear that all the acute trusts in north London were doing similar work and that, as a result, the following Trusts resolved to collaborate: The Royal Free London NHS Foundation Trust,  UCLH, The Whittington and North Middlesex.

The Committee noted that the hospitals met in November 2014 and agreed to develop an approach to incorporate the following aims:

·         a protocol for care for the dying planning

·         a nursing care plan for dying patients

·         prescribing guidelines for care in the last few hours and days of life

·         a leaflet explaining what to expect and the care planning process for patients and those important to them.

Doctor Western informed the Committee that there was an extensive plan for training and education on the subject at the Trust. 

The Committee noted that the approach was in its infancy but that the Trust felt that it was being well received so far.

Ms. Sanders advised the Committee that the Task and Finish Group was very thorough and that the Group was keen to ensure that the Pathway wouldn’t be replaced with the same principles but under a different name.  Ms. Sanders stressed the importance of having good governance around the issue.

Responding to a question from a Member, Dr Western advised the Committee that whilst the principles of care for the dying remain the same, they are now evidence based.  Doctor Western emphasised that an important difference was to make it clear to patients and staff that plans should be agreed by the patient.  Doctor Western commented that previously, when the pathway was used incorrectly, decisions were taken without the patient being consulted.  The Committee noted that the new approach was focussed on getting care right for the patient in a way that the patient and their loved ones wanted it to happen. 

A Member questioned if the new approach would apply only to hospice and hospital care and commented that often people would want to be in a familiar place, such as their own home.   Doctor Western informed the Committee that the approach was about care planning for the patient and ensuring that all parties understand what that patient wants and what is available to them. 

The Chairman advised that she had visited a care home where the spouse of a resident had become very distressed because their partner, who had been put on the Pathway, had had their fluids withdrawn.  Doctor Western informed the Committee of the importance of having a full discussion with families and to consider the reasons for such treatment.  Doctor Western informed the Committee that there was research to show that sometimes there is no benefit in giving fluids to a patient and that, in some instances, it can actually cause more harm.  Doctor Western commented on the importance of explaining why clinicians decide to stop fluids and also what the correct treatment for the patient should be.  The Committee noted the importance of communication in these circumstances so that people could understand the rationale of clinicians.  

RESOLVED THAT the Committee note the report from the Royal Free London NHS Foundation Trust.