Caring for people in the last days and hours of life - Guidance

Foreword

In December 2013 the Scottish Government accepted a recommendation that the Liverpool Care Pathway (LCP) should be phased out in Scotland by December 2014. This Guidance and 4 principles are now confirmed as the framework to support the continuous planning, development and improvement underway at a local level across health and care settings in Scotland.

NHS Education Scotland has placed this guidance along with the 4 principles on the Clinical Knowledge Publisher portal for ease of access. This is available at http://www.ckp.scot.nhs.uk/ScottishGovernmentGuidanceEndofLifeCare/?id=1045. This new development also provides an opportunity for sharing examples that capture local learning and resources. I would encourage all NHS Boards to upload local material and make connections with colleagues across Scotland. Further information about how to upload local material is available at Sections 3 and 5 of this Guidance

During the past year palliative and end of life care policy development has been rapidly developing. The importance of leadership, measurement and support for implementation and improvement has been recognised.

Earlier in the year the Scottish Government committed to the development of a Strategic Framework for Action for Palliative and End of Life Care. This new Framework will be published in Spring 2015 and will be informed and shaped through contributions from everyone with an interest in continuously improving the quality of palliative and end of life care in Scotland. This work will be significantly influenced by the improvement-focused model as outlined in our '3-Step Improvement Framework for Scotland's Public Services'.

New clinical guidelines designed to improve the care of people with life limiting illnesses - NHSScotland Palliative Care Guidelines - were published in November 2014. These updated guidelines reflect expert opinion about good practice in the management of adults at the end of life (including but not restricted to last days and hours of life) and provide practical, evidence-based or best-practice guidance on a range of common clinical issues including pain management, symptom control, palliative care emergencies, end of life care and use of medicines. These clinical guidelines can be used by health and care staff in conjunction with the guidance and 4 principles set out in this document and are available to access at: http://www.healthcareimprovementscotland.org/news_and_events/news/news_palliative_care.aspx

I had the pleasure of Chairing the first meeting of the newly established National Advisory Group for Palliative and End of Life Care in November - an important first step in establishing the conditions for future work. The Scottish Partnership for Palliative Care will be developing and refining their approach to deliver enhanced arrangements for engagement with a wider professional/patient/public stakeholder group. This will be an essential element to inform and influence the focus and future work of the National Advisory Group.

Colleagues and I at Scottish Government look forward to working with people whose lives are affected by the issues covered in this guidance, with the new National Advisory Group and a wide range of organisations, clinical and care staff to support this work.

Although I, of course, welcome the opportunity to commend this guidance document to you, I recognise that issuing guidance does not mean that the required actions outlined within it will automatically take place every time this should happen.

This will require support for leadership, measurement and tailored local arrangements to support change and improvement. It will also act as a source of information for colleagues across Government and public services, outlining the principles to inform care delivery and providing the basis for educational and improvement support resources to be targeted as required.

Mechanisms to support learning and to test/refine our understanding of how to reliably implement this guidance is therefore vital. I would therefore encourage you to share learning, feedback and any proposed information that will be helpful to support implementation - you can do this by emailing david.leslie@scotland.gsi.gov.uk

This guidance can then be updated, amended and linked with resources to reflect new insights into how to make this happen for everyone in the last days and hours of their lives.

Professor Craig White
Chair, National Advisory Group for Palliative and End of Life Care
Divisional Clinical Lead
The Quality Unit
Scottish Government Health and Social Care Directorates