End of Life Care

Four out of every ten hospitals are failing patients at the end of their lives. With around half of all deaths in a hospital setting this is a worrying statistic.

Death is changing in the 21st century. It has become an increasingly medicalised event compared with a hundred years ago when the vast majority of people, 85%, died in their own homes, surrounded by family.

For those working in the field of palliative care medicine, the challenge is how to ensure that patients have a good death and often part of that is knowing when a patient is reaching the end of their life. That in itself can be difficult as some patients who appear to be recovering from an acute episode die suddenly and others who may appear to be at the end of life recover unexpectedly.

In the past the standard guidance for end of life care was the Liverpool Care Pathway but a 2013 Investigation led by Rabbi Julia Neuberger found that often the guidelines were misused leading to failings in end of life care.

The NHS can only improve if patients are dealt with as individuals and needs and wishes are dealt with by a proper evaluation of these being given on a case by case basis. Patients dying well and with dignity is now very much the focus for Palliative Care.

Patients vary in age and medical condition and those caring for the dying will encompass all areas of clinical work from neonatal, trauma through to care of the elderly. Those who are performing best engage with the need to tackle the problem in all departments. Making it less ‘end-of-life’ only care but an issue that should be addressed by all clinical groups really helps.

Professor Mike Richards, Chief Inspector of Hospitals for the Care Quality Commission (CQC) said:

In the places that are doing it best…there is a trust-wide strategic group led by a surgeon but making sure they are thinking about care at the end of life for anybody who may die in every part of the hospital, from the medical ward to A & E. And that leadership element is represented at the board level.’

The type of understanding care may include:

  • Talking to patients and their families about what they want and finding out what is important to them
  • Working with community services to ensure that there can be a rapid discharge to allow a patient to die at home

A 2014 report – ‘One Chance to Get it Right’ identified five priorities in end-of-life care:

  • Recognise
  • Communicate
  • Involve
  • Support
  • Plan
  • Do

These key words are all reminders that there is an individual at the centre of the process and finding ways of dying with dignity is essential if we are to improve the one part of life that will come to us all.

If you or an elderly relative need advice regarding access to health or social care provision then contact a member of our Elderly Care Team.

If you are concerned about the quality of medical treatment given to yourself or a relative, contact a member of our Medical Negligence Team on 0345 209 1055.