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Implementing the NICE Clinical Guideline on Care of the Dying Adult

Chaired by Claire Henry Chief Executive of The National Council for Palliative Care this conference provided delegates with support for their service to ensure the clinical guideline is implemented effectively in organisations to improve end of life care, outcomes and experience for dying people and their families.

Following Tony Bonser, Chair, People in Partnership, The National Council for Palliative Care and Dying Matters & Member, Baroness Neuberger’s Independent Review Panel on the Liverpool Care Pathway opening session on ‘Putting personal experience first’, Professor Sam Ahmedzai, Chair, Guideline Development Group Clinical Guideline on Care of the Dying Adult, NICE & Professor of Palliative Medicine, Department of Oncology, School of Medicine and Biomedical Science The University of Sheffield will discuss ‘The New NICE Clinical Guideline on Care of the Dying Adult published in December 2015’. In his presentation Professor Sam Ahmedzai:

  • the NICE Clinical Guideline on Care of the Dying Adult
  • implementation in practice
  • priorities and challenges

In his presentation Professor Sam Ahmedzai stated: 

"The abolishment of the LCP was unprecedented, it had become a misused tick box exercise"

"The number of people dying in hospital has remained stable, death at home or place of residence is rising and the number of deaths in hospices remains very low still only around 1 in 20"

"Communication if we have a plan make sure you share that plan, and it is not sitting on a shelf somewhere"

"We had very little evidence to go on which is why there is no indication on what medication, however we are currently working on this guidance"

"We were not allowed to specify non pharmacological methods on this guidance but I am sure most of you are aware of these"

"NICE is saying do not blanket prescribe anticipatory drugs, however in Scotland do the opposites"

The conference continued with an extended session on ‘Predicting the end of life and managing uncertainty’ from the Marie Curie Hampstead Hospice and North London Palliative and Supportive Care Network. Don Redding, Director of Policy, National Voices followed and discussed ‘Informing and engaging with individuals and their loved ones to plan for end of life: implementing every moment counts’, in his presentation Don Redding looked in-depth at:

  • coordinated care using the National Voices narrative for end of life care
  • ensuring the most appropriate available professional discusses the dying person’s prognosis with them (unless they do not wish to be informed) as soon as it is recognised that they may be entering the last days of life and include those important to them in the discussion if the dying person wishes.
  • developing competence in effective narrative for engagement

In his presentation Don Redding stated: 

"When areas pick it up and implement plans they don’t usually include end of life care, I think there’s something really wrong there"

"In fact CQC have been using this, every moment counts, in their own reviews of end of life care"

"Having a care plan that records who are and the people caring for you making an effort to understand who you are"

Don Redding, Director of Policy, National Voices Full Presentation Click Here

Don Redding is Director of Policy for National Voices, the coalition of national health and care charities working for person centred care. He has led the coalition’s work on coordinated care (integration) since 2011, including the production of five ‘narratives’ expressing people’s perspectives on what they want from better integrated care. Don is a member of the national support group for the integration pioneers areas; and of the national palliative and end of life care partnership which produced the national Ambitions. He is also a former care worker and journalist who has worked for leading voluntary organisations since 1991. He was previously head of policy and communications at Picker Institute Europe.

Following the lunch Dr Dee Traue, Consultant in Palliative Medicine, East & North Herts NHS Trust break delivered an extended session on ‘Improving communication at the end of life: Implementing the Clinical Guideline recommendations on Advanced Care Planning’ followed by Dr Carol Davis, Lead Consultant in Palliative Medicine & Clinical End of Life Care Lead, University Hospital Southampton NHS Foundation Trust who discussed ‘Developing individual care plans and goals for every end of life care patient in line with the new Clinical Guideline’.

Professor Mike Grocott, Member Guideline Development Group Clinical Guideline on Care of the Dying Adult, NICE & Professor of Anaesthesia and Critical Care Medicine & Consultant in Critical Care Medicine, University Hospital Southampton NHS Foundation Trust continued the afternoon session with an in-depth presentation on ‘Implementing the recommendations on medication management and symptom control’. In his presentation Professor Mike Grocott discussed:

  • delivering effective medication review at the end of life
  • symptom control in the last day of life
  • implementing the clinical guideline recommendations  

Professor Mike Grocott, Member Guideline Development Group Clinical Guideline on Care of the Dying Adult, NICE & Professor of Anaesthesia and Critical Care Medicine & Consultant in Critical Care Medicine, University Hospital Southampton NHS Foundation Trust Full Presentation Click Here

In his presentation Professor Mike Grocott stated: 

"How we prescribe the drugs with patient and family"

Important themes

  • Control and choice
  • Benefit and harm
  • Evaluate, review and document in care plan

"Compassion- response to the suffering of others that motivates to help"

"Hydration - very important area and upsetting when mike sees his patients"

"Recommendations and  links to evidence on control of drugs"

"All about the patients control and choice and its our job to carry this out"

Delivering the final closing address on ‘Monitoring adherence to the guideline and monitoring and improving end of life care outcomes moving forward’. Maggie Morgan-Cooke, Programme Delivery Lead, NHS Improving Quality discussed:

  • monitoring progress against the five priorities
  • monitoring adherence to the new clinical guideline at a local and national level
  • measuring and monitoring end of life care outcomes and experience

Maggie Morgan-Cooke, Programme Delivery Lead, NHS Improving Quality Full Presentation Click Here

In her presentation Maggie Morgan-Cooke stated: 

Just got treated for breast cancer

"Coming from a patients experience and diagnosis through care of plan pathway"

"How she was treated as a patient experience, treatment and how she dealt with"

"Must ask the patient!"

"End of life affects all of us in some time in our life"

"If we want to get to the culture of an organisation, we have to get different points of view"

"Lets have leadership at all levels"

"To get it right we must all work together- team, helping patients and families"

"Commissioning tool kit- there will be nothing new in the tool kit as you have everything"

"Performance management change to continuous movement"

"Early feb the commissioning tool kit will be out!"

Maggie Morgan Cooke qualified as a Registered Nurse with the Nursing Midwifery Council UK in 1987.  Maggie gained experience in medicine and surgery finally specialising as an Advanced Nurse Practitioner/ Theatre Sister in Theatres and, Anaesthetics following a  further Post Graduate Course with the English National Board for Nursing in 1991 working in specialities such as renal transplant, neurosurgery and cardiac surgery for over 12 years. Maggie developed her career in healthcare management holding a variety of senior nursing and managerial in both operational and strategic environments. These included responsibilities for NHS Continuing Care and End of Life Care. Maggie is very experienced in working at the interface with NHS organisations to support them improve the patient experience through  service delivery  A key achievement was leading the implementation of the 10 High Impact Changes in collaboration with the wider NHS. The 10 High Impact Changes received a national delivery award in November 2004. Maggie also led a team that won the Nursing Times Leadership Team Challenge in 2007. Maggie is a Lean Practitioner having trained and qualified with the Juran Institute Europe in 2007.Over the past 10 years Maggie has undertaken international work in the USA, Canada, Africa, Norway, and Sweden sharing learning, coaching teams and engaging health professionals in evidence based improvement tools and techniques. Maggie has worked as a senior improvement leader at a national level in the NHS for 15 years, where she has led the development and delivery of a number of national frontline improvement initiatives including the very successful Productive series including ‘Releasing Time to Care The Productive Ward’ after its initial launch in 2008. Maggie is currently the Programme Delivery Lead for End of Life Care, Sustainable Improvement Team, NHS England.

Future events of interest:

Effective Nurse Prescribing in End of Life Care
Friday 15 April 2016 
Hallam Conference Centre, London

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26 January 2016

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