1. Post Liverpool Care Pathway Arundel: 14 th May 2014 Dr Bee Wee National Clinical Director for End of Life Care

2. NHS | Arundel / 14 May 20142 Pre-LCPLCPMore Care Less Pathway reportPost LCP

3. NHS | Arundel / 14 May 20143

5. National End of Life Care Strategy 2008:‘End of Life Care Pathway’ Step 2 Assessment, care planning and review Step 3 Coordination of care Step 4 Delivery of high quality services in different settings Step 5 Care in the last days of life Step 6 Care after death Discussions as the end of life approaches Step 1 Social care Spiritual care services Support for carers and families Information for patients and carers

6. NICE Quality Standard for End of Life Care for Adults (20110) Quality statement 11: “ People in the last days of life are identified in a timely way and have their care coordinated and delivered in accordance with their personalised care plan, including rapid access to holistic support, equipment and administration of medication” NHS | Arundel / 14 May 20146

7. Independent review (Neuberger) NHS | Arundel / 14 May 20147

8. Some key themes LCP used well – and also used badly System-wide approach Culture of care Education and training Lack of evidence base Accountability Documentation NHS | Arundel / 14 May 20148

9. Clinical issues Individual care plan Decision-making Diagnosis of dying Food and fluids Sedation Use of syringe drivers Anticipatory prescribing NHS | Arundel / 14 May 20149

10. Recommendations for…. Department of Health NHS England Health Education England Care Quality Commission General Medical Council Nursing and Midwifery Council NIHR Royal Colleges and others……. NHS | Arundel / 14 May 201410

11. Independent review (Neuberger) NHS | Arundel / 14 May 201411

12. NHS | Arundel / 14 May 201412

13. NHS | Presentation to [XXXX Company] | [Type Date]13 Freebigpictures.com

14. NHS | Presentation to [XXXX Company] | [Type Date]14

15. Fundamental differences Outcomes based approach From DH to multiple ‘Arms Length Bodies’ ‘Unprecedented’ financial constraints Central – ‘National Support Centre’ Matrix working Local commissioning NHS / Arundel / 14 May 201415

16. The new landscape: local agenda NHS | Arundel 14 May 201416 CCGs Local authorities Health and wellbeing boards Commissioning Support Units Local Area Teams Clinical Senates Strategic Clinical Networks Healthwatch PHE LETBs

17. National reports/reviews Francis 1 st report (2010): 18 recommendations Francis 2 nd report (Feb 2013): 290 recommendations ‘More care less pathway’ (July 2013): 44 recommendations Berwick report (Aug 2013): ‘ to specify the changes that are needed’: 10 recommendations

18. Francis and Neuberger Francis 2 – 8: about culture and values Francis 185 and Neuberger 34: increased focus on compassionate care in nurse training, education and professional development Francis 13 and Neuberger 39: development of fundamental standards, which are to be drawn up by the CQC, working with NICE, commissioners, patients and the public Coalition of bodies to set standards

19. Berwick and Neuberger ‘ A promise to learn – a commitment to act: Improving the Safety of Patients in England’ Acknowledging harm done and consider how best to ensure that EoLC plans help minimise harm and ensure no unnecessary harm Wider actions to improve care in response to the Berwick report should reinforce specific actions being taken to improve care in the last days and hours of life

20. Berwick and Neuberger ‘ Berwick 4 and Neuberger 33 and 35: on making staff with the right skills available in the right locations to support effective end of life care Berwick report stresses the need for continual learning: calls for an “ethic of learning” in the NHS (1) NHS to become a “learning organisation” (6) “mastery of quality and patient safety sciences and practices should be part of initial preparation and lifelong education of all healthcare professionals….” (5)

21. Francis and Neuberger: clinical links Francis 236 and Neuberger 14: senior responsible clinician in charge of a patient’s care Francis 241 and Neuberger 18 and 20: nutrition and hydration NMC and GMC guidance Francis 195 and Neuberger 27: ward nurse managers - should know about the care plans relating to every patient on their wards Named nurse per shift responsible for leading care of the dying patient Francis 237 and Neuberger 14 and 33: teamwork to provide collective care for elderly patients decision to initiate end of life care plan OOH palliative care access

22. Francis and Neuberger: clinical links Francis 238 and Neuberger 30: communication with and about patients shared folder at bedside Francis 242 and Neuberger 23: medicines administration starting syringe driver Francis 243: recording of routine observations

23. NHS | Arundel 14 May 201423 Pre-LCPLCPMore Care Less Pathway reportPost LCP

24. Leadership Alliance for the Care of Dying People Statutory organisations: DH and ALB Regulatory organisations Royal Colleges National charities NHS | Arundel / 14 May 201424

25. Priorities for Care 1.Recognise deterioration – reversible or dying? 2.Sensitive communication 3.Involvement in decision-making 4.Needs of those close to the dying person 5.Individual plan of care NHS | Arundel / 14 May 201425