Around the clock care for dying ‘not good enough’

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Posted 04/04/2016 By: Julie Crossley

A national review of end-of-life care has found most hospitals are failing to provide face-to-face palliative care specialists around the clock. The review shows only 16 of 142 hospital sites in England offer specialists on site 24/7.

NHS experts acknowledge steady improvements in the last two years, but warn there is still work to do. This is the first review since the controversial Liverpool Care Pathway was scrapped. The Liverpool Care Pathway was phased out amid criticisms it had been misused as a tick-box exercise, leaving some patients without food and water.

In its place a series of guidelines has suggested moving away from a one-size-fits-all approach, instead focusing on individual care. There have been improvements in all areas. Researchers found, for example, that communication with patients and relatives had improved. But there were still a number of concerns.

In 18% of more than 9,000 patient notes examined by researchers, there was no written evidence to suggest that do-not-resuscitate decisions had been discussed with relatives or friends. In around 3,000 notes there was no evidence that the patient’s ability to eat and drink had been assessed on the last day of life.

The main concern was that many patients and doctors did not have full access to on-site palliative care specialists at evenings and weekends. The majority of hospitals did offer a specialist telephone helpline at all times and 53 of 142 hospital sites offered face-to-face palliative care on Monday to Sunday between 9am to 5pm. But for 26 trusts there was no record of face-to-face specialist palliative care involving doctors at any time.

Problems occur when things start to go wrong and often they go wrong out-of-hours in the middle of the night and at weekends. Then doctors and nurses who may be inexperienced need to be able to access specialists in palliative care.

Julie Crossley, a medical injury lawyer at Ashtons Legal, comments: “This is a difficult subject and causes a huge amount of distress to patients and families at the worst of times. It is something which needs to be rectified so that patients and their families are provided with optimum care throughout. Families do become upset at the way loved ones are treated and do seek legal advice not usually with regard to compensation but to ensure the same thing doesn’t happen to other people”.


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