We’ve seen today (16th December 2015) the release of new guidelines from the National Institute for Health and Care Excellence that are intended to improve care for people in their last days of life. The question is…to what extent are these an improvement?
Unsurprisingly, this Review has uncovered issues strongly echoing those raised in the Mid Staffordshire Public Inquiry: notable among the many similar themes arising were a lack of openness and candour among clinical staff; a lack of compassion; a need for improved skills and competencies in caring for the dying; and a need to put the patient, their relatives and carers first, treating them with dignity and respect.
Alongside colleagues at UCS I have been fortunate to work on a number of projects with those in later life (although not specifically with those in their last days of life) that have sought to improve the quality of care that is provided. One of the concepts that we have used to try and address these challenges is the ‘ethic of care’.
This approach emphasises the importance of the relationships between those providing care and those in receipt of care. Key to ensuring that this works well is to allow the person providing the care services to react and respond to the individual needs of the person that they are supporting, rather than trying to deliver a standard service. Many recent reforms have moved care provision in the opposite direction or made it more difficult to deliver this type of care – you may wish to read more on this. These guidelines seem to suggest a very different way forward.
Some of the provisions in the new guidelines appear to mirror thinking from the ethic of care. An emphasis on communication and shared decision-making should certainly be welcomed, particularly if it can help individuals to be active in developing an individual care plan. As an example, the recommendation that dying people should be supported to drink if they want to – recognising how this might contribute to care even in the last moments of life – illustrates how an individualised approach means that different people in different circumstances can, and should, be treated differently. It is particularly welcome that the chair of the development group, Professor Sam Ahmedzai comments
“The main way this guideline differs to the LCP is that it stresses an individualised approach rather than a ‘blanket’ method of using the LCP in an unthinking way. The guideline also stresses that the patient should be reviewed daily, and the person should always be taken as an individual.”
Of course, we can’t make judgements about the impact that new guidelines will have until we have seen how they are implemented in practice. To that end, we will have to keep a watch but should remain hopeful that this could signal a change in the way we think about great quality care at all stages in life.