end of life care

There are serveral strategies and docuements which provide guidance to good end of life care. Set out below are the key ones


End of Life Care Strategy

The strategy was developed over a period of a year by an advisory board led by Professor Mike Richards
and six working groups, consulting over 300 stakeholders. It became apparent that a whole systems approach was required. Accordingly the Strategy strongly recommends that a care pathway approach should be followed both for care and the commissioning of end of life care.
Key Steps
Identification of people approaching the end of life, and initiating discussions about preferences for end of life care;
Care planning: assessing needs and preferences, agreeing a care plan to reflect these and reviewing these regularly;
Coordination of care;
Delivery of high quality services in all locations;
Management of the last days of life;
Care after death; and
Support for carers, both during a person’s illness and after their death.
The themes set out in the strategy have built on the best available research evidence and on existing experience from:
Voluntary hospices, many of which have been beacons of excellence in end of life care since the foundation of the modern hospice movement by Dame Cicely Saunders at St Christopher’s Hospice in 1967.
The NHS End of Life Care Programme (2004–2007), which has contributed significantly to the rollout of programmes such as the Gold Standards Framework (GSF), Liverpool Care Pathway for the Dying Patient (LCP) and the Preferred Priorities for Care (PPC).
The Delivering Choice Programme currently being run by Marie Curie Cancer Care.

Gold Standards Framework

The Gold Standards Framework (GSF) is a systematic evidence based approach to optimising the care for patients nearing the end of life in the community. It is concerned with helping people to live well until the end of life and includes care in the final year of life for people with any end stage illness in the community.

The aim of GSF is to develop a locally-based system to improve and optimise the organisation and quality of care for patients and their carers in the last year of life. It forms a component of the End of Life Care Initiative and is now being piloted in Care Homes.

Essentially the GSF is a simple common-sense approach to formalising best practice, so that good care becomes standard for all patients every time.

Liverpool Care Pathway
The Liverpool Care Pathway (LCP) for the dying patient has been developed to transfer the hospice model of care into other care settings.

It is a multi-professional document which provides an evidence-based framework for end-of-life care.

The LCP provides guidance on the different aspects of care required, including comfort measures, anticipatory prescribing of medicines and discontinuation of inappropriate interventions.

Additionally, psychological and spiritual care and family support is included.

The LCP replaces all other documentation in this phase of care and is applicable in hospital, hospice, nursing home and community settings. The LCP is a key recommendation in the NICE guidelines for supportive and palliative care. It is used within our In-patient unit.