Doctor welcomes individual end of life care plans

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A LEADING doctor at Portsmouth’s hospital has welcomed the scrapping of a controversial end of life care plan.

The Liverpool Care Pathway (LCP) was a tool adopted by hospitals to extend hospice-type care if it thought patients were approaching the end of their life.

It was developed in Liverpool by the Royal Liverpool University Hospital and Liverpool’s Marie Curie Hospice.

But it is to be phased out nationally over the next six to 12 months, following a government-commissioned review.

It concluded the pathway itself was not a problem, but poor training meant it wasn’t being used properly.

Queen Alexandra Hospital, in Cosham, started using the LCP in 2005.

Dr Ian Cairns, consultant in palliative medicine and end of life lead at QA, said that although there’s a problem nationally, the pathway is being used correctly in Portsmouth.

He said: ‘In itself the use of the LCP with a support team is beneficial.

‘About 40 to 50 per cent of the Portsmouth community will die in hospital, so this is core business for us, and we have to get it right.

‘Communication is key, and from what I’ve seen, this is happening in QA.

‘Someone needs to recognise that a person might be dying.

‘Then it’s important to talk to the patient, or to their family.

‘It’s communication to see if the patient can go home, or if they’re too ill then they have to stay at the hospital.

‘If so, is it important they get their own room, and if they need changes in their treatment.’

Around 2,190 people die in QA each year. Since July 2010, 48 complaints have been made to Portsmouth Hospitals NHS Trust, which runs QA, on end of life care, including the LCP.

‘If you have irreversible causes of a disease and it is acknowledged you may die,’ added Dr Cairn.

‘A clinical review with the family is done of the patient, and from there you go to basic care.

‘You make sure the patient is comfortable, their symptoms are controlled, and something is being done about pain, nausea, secretions and agitation.

‘The patient is checked by a nurse a minimum of every four hours, by a ward doctor everyday, and by a consultant every three days.

‘But this happens more often, each time staff are available.

‘So at QA, individual patient care is always looked at and monitored.’

The review came up with a list of 44 recommendations, including a new plan set up that provides individualised care.

Dr Cairn added: ‘I welcome the report and its change on individual care plans for patients.

‘At QA we are doing this really well already.’