PMHi, my name is Patrick McDaid, I’m a palliative care facilitator in Camden. The talk was End of Life Care educational events for Camden GPs.
IVThere are a number of measures around end of life care. Are there any changes of note for Camden residents over the last few years?
PMOne of the biggest is the proportion of people dying in hospital in Camden has decreased immensely. So, whereas we used to be at the London average, which is above the national average, we're now the lowest in London and below the national average. So, currently there is 48% of people dying in hospital. That's the end of 2013. That's a big shift which reflects the attention to detail around chronic disease management and care planning that's been given, which directly leads on into end of life care being much easier to achieve because you've got the organisation around people.
The second big thing is palliative care registers in the last three years have shot up. We've gone from under 400 to nearly 700 in the last three years. DNACPR documentation has increased hugely, as has the recording of the preferred place of care. All of these things make it possible for people's wishes to be made at their final moment of life.
IVAs a GP what's your take on the new NICE guidance for end of life care?
PMThe new NICE guidance end of life care is an easier read than a lot of NICE guidance. It has been brought out following the demise of the Liverpool Care Pathway and it picks up on the review that followed the demise of the Liverpool Care Pathway of some of the main failings that were thought to exist. These include the involvement of a senior clinician in recognising and diagnosing somebody being at the end of life and in the community that's GPs. They're the main person... the most senior practitioner involved.
Also, it picks up on potential for blanket prescribing where this is done without regard for the individual circumstances and this in turn has led to accusations under the LCP, the Liverpool Care Pathway, that people were over-sedated and they were over-treated because of a blanket policy. The new guidance emphasises treating people as an individual.
The third thing that it picked up on was the perceived removing of hydration and medications from patients. So, it addresses all of these and it does it by referring to the five priorities of care that came out last year.
These include communication, recognising, obviously, that people are dying or that it's a reversible situation involving the individual and the people important to that individual in information about what's happening to them, in discussions about the decisions that you're going to make when you're planning the care in the here and now and going forward, anticipating the final days and things that might go wrong. And a very strong emphasis on plan, do and review. So, the reviews need to be timely. We're talking about the last few days of life here, so that's not bad advice.
Other points in the NICE guidance include around symptom management but the palliative care guidance that we've got locally, visit the website, already covers this very well. It's about to be revised. There are a few little additions. Included in that would be a reference to hydration. Hydration is quite an emotive thing. The truth is very few people would need extra hydration but there is guidance on that in the new NICE guidance, which is worth taking a look at.
IVWhere can GPs find out more?
PMSo, they can come to me directly. So, that's Patrick McDaid. My e-mail address is . My mobile number is 07939 119 131. They can also go to the CCG website and the palliative care section on that has got all this information, or will have very shortly. And, of course, the NICE guidance is available on the NICE website, NG31 for this particular version.