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

Purpose of this document

In December 2013 the Scottish Government accepted the recommendation that the Liverpool Care Pathway (LCP) should be phased out in Scotland by December 2014. The national statement published today confirms the current position as set out below.

Health and Care providers across Scotland are committed to the provision of consistently high quality end of life care for all that reflects the 4 principles set out in this guidance 'Caring for people in the last days and hours of life^[1]'

Principle 1: Informative, timely and sensitive communication is an essential component of each individual person's care

Principle 2: Significant decisions about a person's care, including diagnosing dying, are made on the basis of multi-disciplinary discussion

Principle 3: Each individual person's physical, psychological, social and spiritual needs are recognised and addressed as far as is possible

Principle 4: Consideration is given to the wellbeing of relatives or carers attending the person.

This Guidance and associated principles are now confirmed as the framework for further planning and development at a local level across Scotland.

Scope of this document

The principles set out within this document are applicable in all care settings.

There can be uncertainty involved in identifying when someone is dying - illness can be unpredictable, and change can occur suddenly and unexpectedly. This is an important consideration highlighted within the principles in section 1. This document is designed to provide guidance relating to the end of life, where 'end of life' is defined as 'when the team caring for the person agree that death is expected within hours to days and a natural death is occurring with all possible reversible causes having been considered'.

How to use this document

This document does not provide detailed instructions or a list of steps to be taken. Each individual person is different. The principles in this document should inform the thinking which is necessary to provide person centred care which meets the needs of each individual person.

Staff can be confident that they are providing good care for people who are in the last days and hours of life by:

• adhering to the principles set out within section 1 of this document; and
• ensuring their care takes into account the uncertainty involved in identifying if someone is dying,
• understanding the importance of sensitive and clear communication with people and their families,
• understanding the role of hydration and nutrition at the end of life, as explained within section 2; and
• following locally recognised good practice guidance on end of life care (section 5), and/or the good practice guidance referenced within section 3 of this document; and
• directing people and families to relevant information, as referenced within section 4 of this document.